What Causes Travelers' Diarrhea?

Have you ever had an upset stomach while traveling abroad? You might have dealt with travelers' diarrhea, a condition similar to food poisoning. Each year, more than 15 million people who visit South or Central America, Africa, India, and other developing countries experience travelers' diarrhea, reports a 2005 review featured in the journal Clinical Infectious Diseases. Its symptoms last about four days, but some individuals may develop life-long complications, such as irritable bowel syndrome (IBS).

This gastrointestinal infection causes nausea, stomach pain, and three or more loose stools within a 24-hour period. In some cases, it only causes diarrhea. Other symptoms may include vomiting, fever, stomach growling, or blood in the stool, according to the MSD Manuals. On the positive side, most cases of travelers' diarrhea are mild and do not require medical treatment. Less than 1% of those who contract the disease need hospitalization, but 12% to 46% end up changing their travel plans, reports TravelHealthPro.

About 7% of people who travel to the U.S., Canada, Western Europe, Japan, Australia, and other developed countries experience this problem. The risk is slightly higher for those who visit South Africa, southern Europe, and the Caribbean, but you can take preventive measures to avoid getting sick, says TravelHealthPro. For starters, here's what you should know about the most common causes of travelers' diarrhea and how to stay safe. 

How do you get travelers' diarrhea?

While it's common to have an upset stomach due to stress or trying new foods, travelers' diarrhea is usually caused by bacteria. Escherichia coli, Salmonella, Campylobacter jejuni, and other bacterial species are responsible for up to 90% of all cases of diarrhea in travelers, reports the Centers for Disease Control and Prevention (CDC). Another 5% to 14% of cases are due to viral infections, which may occur following exposure to noroviruses, rotaviruses, or other pathogens. Less commonly, this condition may be caused by protozoan pathogens like Giardia and Cyclospora.

Travelers' diarrhea usually occurs 12 to 72 hours following the consumption of food or water contaminated with pathogens, according to the MSD Manuals. For example, you may experience this problem after eating improperly stored or prepared meat, fish, or eggs. The risk is higher among travelers who've had gastrointestinal surgery or take medications for peptic ulcers, notes Johns Hopkins Medicine.

Certain groups — especially teens and young adults — are more likely to get travelers' diarrhea, notes a 2018 review published in the journal Gastroenterology and Hepatology. Backpackers and travelers who eat street food are at risk, too. This condition seems to be more common in those with compromised immune systems, IBS and other digestive diseases, or low stomach acid. Alcohol consumption can further increase your risk of diarrhea, according to the researchers. 

What's the best way to prevent travelers' diarrhea?

Although it's not always possible to prevent travelers' diarrhea, there are steps you can take to minimize the risk. First of all, practice good hygiene and avoid street food. Only drink bottled beverages and use boiled water for making tea or coffee and washing your hands. Steer clear of raw meat, shellfish, and unpasteurized eggs or dairy, and refrain from putting ice in your drinks, suggests Johns Hopkins Medicine.

If you want to be extra cautious, you can take Pepto-Bismol or other medications containing bismuth subsalicylate during your trip. Note, though — these drugs may not be safe for those with gout, kidney problems, aspirin allergy, and other health problems, warns the CDC. Probiotics can help, too, but they may take some time to start working. Antibiotics shouldn't be used as a preventive measure. 

Last but not least, make sure you know when you see a doctor. Johns Hopkins Medicine recommends calling your healthcare provider if you have a high fever, severe diarrhea, blood in the stool, or worsening stomach pain. If you have mild diarrhea, consider taking loperamide or bismuth subsalicylate, says the CDC. In more severe cases, your doctor may prescribe azithromycin, rifaximin, or other antibiotics. Meanwhile, drink plenty of fluids to prevent electrolyte imbalances and dehydration. The CDC recommends using an oral rehydration solution, but you may also prepare a mixture of salt, sugar, and water, according to the University of Virginia