By Dr. Mark Wise
Causes || Prevention
Diarrhea is the most common ailment amongst travelers to the tropics.
It goes by several names, depending upon where you succumb, such as
Montezuma's Revenge, Delhi Belly and Seeping Slickness! Your risk of
developing diarrhea depends upon:
- your destination (some places are worse than others)
- the precautions you take
- your style of travel
- luck (some people are luckier than others)
You may become infected through the water you drink, the ice cubes you
use, the food that is washed by water such as fruits and vegetables,
people handling your food, the flies landing on your food, and food
that is not adequately cooked.
There are many causes of diarrhea, most of which are infectious. The
most common causative organisms are bacteria, such as E. coli, salmonella,
shigella and campylobacter. Parasites or protozoa such as
giardia lamblia, Entamoeba histloytica, cyclospora and cryptosporidium
occur much less frequently. Cholera, a bacteria, is a very rare cause
of diarrhea amongst travelers. Sometimes, diarrhea is not due to infection
but perhaps too much sun, fruit or booze.
Diarrhea may be mild with just some cramps and a few loose bowel movements
per day, or much more severe. Dysentery refers to diarrhea associated
with blood and pus and fever, and it is usually caused by one of the
bacteria. This is the sort of experience that makes some people choose
Florida over Mexico!
Your best bet is to follow the Mexican proverb "Boil it, bottle
it, peel it, cook it .... or forget it." Having said that, this
is not always practical, affordable, or polite, depending upon your
To purify water, the best method is to boil it. It is probably not necessary
to boil it for 10 minutes, which might result in you losing most of
the water. Rather, just bringing it to a rolling boil is probably sufficient.
If you buy bottled water, you should ensure that there is an unbroken
seal on the bottle.
Iodine, which is available as drops or crystals, will adequately purify
your water, but might leave an unpleasant taste. Adding some Coolade
(it was around in the 60's) will help eliminate that taste.
There are several water "purifiers" on the market. They vary
in size, price, mechanism and duration of action. For a good selection,
you might consider visiting Mountain Coop or some other well-equipped
Vegetables can be cooked, or washed in iodine (bleach) and then rinsed
with safe water. Meat should be well-cooked, as undercooked beef, pork
or fish can be the source of tapeworms, which may grow to thirty feet
In spite of the above advice and precautions, up to 40% of travelers
to the tropics will get the runs. So let's talk about self treatment.
1. Replace your fluid losses, with oral rehydrations salts (ORS,
Gastrolyte), flat carbonated drinks, soups (add salt), tea (add sugar)
or water, if it is clean.
2. Lighten your diet, avoid milk products, try bananas, rice water,
3. Antiperistaltics (they slow down your bowel) such as Imodium,
can safely be used for mild to moderate non-bloody diarrhea. Do not
use too much Imodium, or your next bowel movement might not be until
the next millennium. Pepto Bismol may also provide some symptomatic
relief. There certainly are those who feel that is inadvisable to
use antiperistaltics, as they keep the offending bacteria in contact
with your bowel for longer. This view is OK, as long as you have time
to get over your diarrhea, and have a good source of toilet paper.
It is not OK if you have a plane to catch, a camel to ride, or one
day to see the Taj Mahal.
4. Antibiotics, such as Noroxin or Cipro may help, considering that
most cases of acute diarrhea are caused by bacteria. For the fastest
relief, a combination of Imodium plus the antibiotic is recommended.
5. Some cases, especially the more chronic, may be assumed or proven
to be parasitic infections such as giardiasis or amebiasis, which
may be treated with drugs such as metronidazole (Flagyl) or tinidazole
Hopefully after some of the above treatment, you are all better. But
this is not always the case. Remember,
"Travel expands the mind.... but loosens the
© Copyright 2000 Dr. Mark Wise
Dr. Mark Wise is the director
of The Travel
Clinic (TM)) in Thornhill, Ontario, Canada and the Medical Director
of The Travel Wise (TM) Clinic in Scarborough, Ontario, Canada. He is a
family physician with training from the London School of Tropical Medicine
in Tropical Diseases. He is a parent himself and often see potential adoptive
parents in his clinic. Dr. Wise gives lectures and writes articles on the
subject of travel medicine, for both medical and non-medical groups.