It's probably the most unpleasant minor traveler's malady. Unfortunately, it's also probably the most common.
Call it what you will -- Montezuma's revenge, the traveler's trot, the Toltec two-step, Delhi belly, the runs, traveler's tummy or the commonly accepted TD (for traveler's diarrhea) -- but don't call it fun. Symptoms include diarrhea, stomach cramps, nausea and vomiting. Further, it can be dangerous, causing severe dehydration, malnutrition or worse.
The Centers for Disease Control and Prevention (CDC) reports that between 20 and 50 percent of international travelers suffer some form of TD. A vaccine against E. coli, the most common cause of TD, has been under development for over a decade now -- and there's no sign that it will be released any time soon. Until then, here are our tips for preventing, identifying and treating traveler's tummy.
Avoidance Is the Best Policy
Avoiding TD is your best tactic. Skip the ice cubes in your drink, pass on salads or other raw foods, and seek out bottled water rather than drinking from the tap. For more tips on avoiding TD, read our article on Food Safety.
Worldwide Risk Levels for TD
Note that in high-risk areas, it may be all but impossible to avoid some incidence of TD. Here's a breakdown of your risks around the world:
High Risk: Most developing countries in Latin America, the Middle East,
Africa and Asia
Intermediate Risk: Some Caribbean islands, some Eastern Europe countries, South Africa, Argentina and Chile
Low Risk: The United States, Canada, Northern and Western Europe, some Eastern Europe countries (like Poland and Slovenia), New Zealand, Australia and some Caribbean islands
For more details, check out the CDC's destination-specific health information.
Causes of TD
A change in diet, dehydration from flying, a change in climate, stress and even lack of sleep can cause simple traveler's diarrhea. The most common cause of TD is bacteria, particularly E. coli, but many other microbes can lead to intestinal distress.
In most cases, TD is easily treated, a mere inconvenience in your travels. However, more serious ailments are possible, including dysentery, cholera, giardiasis and other intestinal disorders. See below for more on these conditions.
Identifying TD
As outlined above, symptoms can include diarrhea, stomach cramps, nausea and vomiting. These symptoms can be relatively severe, but should not persist for more than 48 hours or so, or become particularly violent. Even simple TD can be life-threatening under some conditions, so consider seeking medical attention if symptoms worsen or continue for more than a day or two.
Common bacterial diarrhea usually sets in very rapidly and without warning and is not typically accompanied by bloody stools. About 85 percent of TD is considered bacterial diarrhea, according to the CDC.
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There are other, arguably more serious maladies that cause similar or identical symptoms to common TD:
Amebiasis (amebic dysentery): The appearance of blood or mucus in the stool is a sign of potential dysentery. In this case, you should seek medical advice.
Giardiasis: This is a somewhat more complex intestinal disorder that can recur repeatedly for weeks after the conclusion of travel, as the protozoan that causes it has a longer incubation period than most bacteria. Symptoms include diarrhea, nausea, bloating, abdominal cramps, fatigue and more, and may not appear until a week or two after the protozoan is introduced into your body. If you find yourself having repeated outbreaks of TD even after your trip is over, or if your symptoms persist longer than 48 hours, seek medical attention.
Cholera: The appearance of severe, watery diarrhea spotted with mucus can be indicative of cholera. It's important for cholera sufferers to quickly replace their body's lost water and salts to prevent dehydration. They may also need medical help.
Other conditions accompanied by fever, lethargy, persistent diarrhea lasting more than 48 hours, or severe diarrhea may require treatment with antibiotics and are cause for medical intervention.
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Dehydration and TD
Many of the symptoms of TD can be caused by simple dehydration. Your first approach should be to rehydrate. Even if you have E. coli contamination, you'll need to keep yourself hydrated since you'll be losing fluids rapidly. Of course, you must use a clean water source.
The CDC offers a broad view of the topic.
Treatments (Not Always Cures)
Symptoms of TD usually clear up on their own after a day or two. To speed your recovery, you'll want to alter your diet. Staying hydrated is your first priority. Drink bottled fluids and avoid caffeinated drinks such as soda, coffee and tea, as well as alcoholic drinks.
The most common treatment for TD is the use of Pepto Bismol, or the stronger Imodium, but understand that these products merely relieve the symptoms and don't actually provide a cure. In fact, in severe cases of abdominal distress, the tendency of these treatments to "block up" your digestive system can actually be counterproductive or dangerous.
Note that these products may contain aspirin, and that the active ingredient, bismuth subsalicylate, can cause a blackening of the tongue and stools, and occasionally ringing in the ears. These side effects disappear when treatment is discontinued.
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Antibiotics should generally only be taken in severe cases. Two common and effective antibiotics are Ciprofloxacin, also known as Cipro, and Norfloxacin. Once symptoms relent, you can discontinue taking the antibiotic; doctors indicate that you don't have to see the treatment through full cycle as with most antibiotics. If you're headed to a developing country, you may want to ask your doctor to prescribe you a course of antibiotics to take along just in case.
These treatments are useful in the case of "bacterial diarrhea," but not for amebic dysentery, viruses or food toxins. In fact, in these cases, you can make your infection worse. A simple rule: If there is blood in your stool, or if you have a fever, pass on these products and see a doctor.
When to Seek Medical Attention
If there is blood or mucus in your stool
If you have a fever
If symptoms persist for more than 48 - 72 hours
If you cannot keep down light food or liquids
