Diarrhoea Up to 50 per cent of travellers are affected by diarrhoea, depending on their holiday destination. In severe cases, if not treated promptly and effectively, it can prove fatal.

In this article

High-risk destinations Who's affected?

When to seek help Best treatments

Prevention

Diarrhoea is a common travellers' complaint, often associated with changes in water and food. The most important determinant of risk is destination.

High-risk destinations include most of the developing countries of Latin America, Africa, the Middle East and Asia.

Medium-risk destinations include most southern European countries and a few Caribbean islands.

Low-risk destinations include Canada, northern Europe, Australia, New Zealand, the US and a number of Caribbean islands.

Diarrhoea is slightly more common in young adults than in older people. The reasons for this difference are unclear. A lack of acquired immunity, more adventurous travel styles or different eating habits may play a part.

Attack rates are similar in men and women.

Diarrhoea usually strikes within the first week, but may occur at any time during the holiday - even after returning home.

If symptoms persist for more than 24 hours or if you develop a high temperature, consult a doctor.

The main risk with diarrhoea is dehydration. However, drinking water will actually encourage the loss of more salts from your body.

Instead, drink an isotonic solution - a quarter of a teaspoon of salt and three level teaspoons of sugar in one pint of sterilised water. This should be drunk at the rate of about a half to three-quarters of a pint every two hours or after each visit to the toilet.

Avoid alcohol, which leads to further dehydration.

Over-the-counter diarrhoea medicine can help if you experience griping pains in the abdomen.

Always wash your hands before eating or handling food and after using the toilet. Also, keep your hands away from your face and don't bite your nails.

Undercooked and raw meat, fish and shellfish may carry intestinal pathogens. Cooked food that has been allowed to stand under heat lamps for several hours also provides a fertile breeding ground for bacteria. Food from street vendors is also associated with increased risk of stomach upsets.

Boil it, cook it, peel it or forget it

Eat only food that has been cooked and is still hot, or fruit you've peeled yourself. Remember, boil it, cook it, peel it or forget it.

Some fish and shellfish contain poisonous biotoxins even when well-cooked. The most common type of fish poisoning is ciguatera fish poisoning. Barracuda is the most toxic fish and should always be avoided. Red snapper, grouper, sea bass and other tropical reef fish contain the toxin at unpredictable times of the year.

In areas of poor water sanitation:

• Don't use water direct from the tap.
• If the water is of suspect quality, boil it for at least five minutes. It can then be stored in clean, covered containers for use within 12 hours.
• Make sure bottled water or canned drinks are opened in your presence. Dry the outside and clean the area that will be in contact with your mouth.
• Avoid using ice unless you know it's safe.
• Only wash food in boiled or sterilised water.
• Don't eat salads, unless you know they've been cleaned in sterilised water.
• Use sterilised water to brush your teeth, clean grazes or cuts, and clean contact lenses.
• When in doubt, stick with hot drinks such as tea and coffee, canned or bottled carbonated beverages, beer and wine.

This article was last medically reviewed by Dr Trisha Macnair in September 2006.
First published in May 2001.