Diarrhoea on holiday

High-risk destinations

Infective diarrhoea (also often referred to as gastroenteritis) 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.

Who's affected?

Diarrhoea is slightly more common in young adults than in older people. The reasons for this difference are unclear. A lack of acquired immunity (because they haven’t been exposed to so many different bacteria), more adventurous travel styles or different eating habits may play a part.

Attack rates are similar in men and women.

When to seek help

Diarrhoea usually strikes within the first week when you are first exposed to bacteria and viruses that are new to you but which the locals have learned to tolerate. But it may occur at any time during the holiday - even after returning home.

You may or may not also have nausea and vomiting. If symptoms persist for more than 24 hours, if you pass blood in the motions or if you develop a high temperature, consult a doctor.

When babies or small children are affected get medical advice sooner as they candehydrate and run into problems very quickly.

Best treatments

The main risk with diarrhoea is dehydration. So you should aim to replace the fluid you lose, by drinking small amounts of water or fruit juice often. Generally it’s not critical what sort of fluid you drink, although you should avoid alcohol which can lead to further dehydration. So if someone is feeling nauseous and can only face fizzy drinks, that should be fine.

However, drinking a lot of water can actually encourage the loss of more salts from your body. If the diarrhoea is severe, you should try to drink an isotonic solution – you can buy these sort of solutions especially for diarrhoea in the pharmacy. They usually come as sachets of rehydration salts in powder form that you make up, and it may be worth taking a supply when you travel.

Alternatively you can make your own solution by mixing a quarter of a teaspoon of salt and three level teaspoons of sugar in one pint of sterilised water (take care to be accurate as too much salt can be harmful). 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.

Over-the-counter diarrhoea medicine can help, for example if you experience griping pains in the abdomen. Another commonly used drug, loperamide, slows down the action of the bowel and is very effective in treating diarrhoea. You can buy it in the pharmacy without a prescription – always follow the instructions in the packet.

When diarrhoea persists antibiotics may help to reduce symptoms.

Prevention

Good hygiene is vital. 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. Take an alcohol hand gel sanitizer with you for use when you can’t wash your hands.

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.

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.