Traveller's diarrhoea

Traveller’s Diarrhoea: Lets get to the bottom of it

It’s no secret that travelling can upset even the most regular bowel.

Travelling can be stressful, you’re eating new foods and you could even be in a different timezone – all of which are known to affect bowel regularity.

But, if you’ve ever had traveller’s diarrhoea, you’ll know this can be far worse.

So what is Traveller’s Diarrhoea?

Commonly referred as “Bali Belly”, traveller’s diarrhoea (TD) is usually caused by enterotoxigenic Escherichia coli (ETEC) bacteria.  Most of us know this by its more common reference – E.Coli.  More correctly though, ETEC is a group of E.Coli.  Salmonella is another culprit.  Combined, E.Coli and Salmonella cause somewhere between 50-80% of TD cases.  Other causes include parasites and viruses.

Typically, traveller’s diarrhoea is contracted after eating food (or drink) that is contaminated with organisms from faeces (either human or animal).

Once in the digestive system, E. Coli produces toxins that stimulate the lining of the intestines causing them to secrete fluid.  This excessive production of fluid is the cause of the diarrhoea.  It’s not pretty – but it is pretty common especially in developing regions where sanitation and hygiene tend to be questionable.

What are the symptoms?

Most of us have had some experience with diarrhoea and the symptoms of traveller’s diarrhoea are pretty much the same.  The most common symptoms are watery stools, abdominal cramping together with frequent and urgent need to evacuate the bowel.  Other less common symptoms include;

  • Fever and/or chills
  • Nausea
  • Headache
  • Bloating
  • Muscle aches
  • Loss of appetite
  • Vomiting

Symptoms manifest within 1-3 days after exposure to the bacteria and usually last 3-4 days.  Most cases can be treated conservatively and it is rare for treatment to involve hospitalisation or antibiotics.


Formal diagnosis can only be made when the bacteria are cultured from a stool sample in a laboratory.  However, the techniques and facilities required to make a formal laboratory diagnosis aren’t widely available.

Doctors tend to reach the diagnosis of traveller’s diarrhoea based on the patient’s symptoms and history.  To be classified as severe diarrhoea, the patient would need to have experienced at least 3 unformed bowel motions within a 24 hour period and also report symptoms typical of the condition (eg abdominal cramping, nausea etc).  Moderate or mild diarrhoea is diagnosed in cases where the patient has experienced 1 or 2 unformed bowel movements in a 24 hour period together with associated symptoms.


Most cases of traveller’s diarrhoea don’t require specific treatment.  General medical advice is that the patient should consume clear liquids to prevent dehydration and loss of electrolytes.   Water is essential and if salty liquids such as chicken soup are not available, over-the-counter medications such as oral rehydration solutions can help.

Many people find over-the-counter medications which reduce the number of bowel motions of benefit.  Just be mindful that use of these preparations slows down the passage of the gut’s contents and this can result in the body taking longer to expel the toxin.

Antibiotics may be prescribed but medical advice is that ETEC is often resistant to common antibiotics and in which case, this course of action may prove useless.

Other treatments include anti-nausea medication and avoidance of certain food groups which are known to irritate the gut.  These include dairy products, alcohol and spicy foods.

Last but not least, rest.  No one wants to be stuck in a hotel room on holiday but it is the best place to be while your body rids itself of the infection.  Rest is the best way to help yourself get better sooner.

Risk Factors

It doesn’t matter how careful you are with food and drink when travelling – between 30%-70% of travellers will experience it.  Whether you succumb to it depends largely on where you travel.

There is no doubt that TD is more prevalent in areas where local sanitation and hygiene standards tend to be poor.  High risk regions include Asia, the Middle East, Mexico, Central and South America.  The risk is still present (but less so) in more developed areas such as Europe, Australasia, North America and Japan.

Age is also a factor with younger travellers being more susceptible.  General medical consensus is that in the case of younger travellers, their immune system is less developed and this predisposes them to infection.  Also, adolescent or young adult travellers may be more adventurous and in some cases more inclined to take risks.

Those who suffer certain pre-existing medical conditions are also at a higher risk.  Most notable conditions include Type 1 Diabetes, heart failure, HIV, advanced cancer, reactive arthritis and inflammatory bowel diseases.

People who take acid blockers or antacids also run a higher rise given that these medications reduce the amount of acid in the stomach.  Acid is known to destroy organisms and so a lower acid level may allow bacteria to survive.

When you travel also seems to play a part as the risk of traveller’s diarrhoea varies according to season in some places.  In South Asia, the risk is highest during the hot months immediately prior to monsoon season!


There is no vaccination to prevent traveller’s diarrhoea and prevention is the best form of defence.  As consumption of contaminated food and drink are the most common causes of this condition, tips for prevention include avoidance of various food types including:

  • Raw and peeled fruits and vegetables
  • Fruits and vegetables that cannot be peeled (eg berries)
  • Salad greens (which may have been washed in contaminated water)
  • Raw, rare and undercooked meats
  • Seafood
  • Dairy products (inc milk, yoghurt and ice cream)
  • Food from street vendors
  • Hot food which has been allowed to cool to room temperature
  • Food buffets and smorgasbords

Try to stick to thoroughly cooked foods and drinks which are served to you whilst hot.  It’s also a good idea to choose fruits and vegetables which you can peel yourself (eg bananas, oranges).

In terms of beverages and water;

  • Avoid local water and/or drinks that contain ice
  • Buy bottled and sealed water to drink (preferably carbonated)
  • Use bottled water to clean your teeth
  • Avoid using tap water to wash fruit, vegetables or salad
  • Avoid swimming in water which may be contaminated
  • Keep your mouth closed while showering

At any time you use the toilet, make sure you wash your hands thoroughly with soap and water.  Also ensure your hands are completely dry.  This also applies before consuming food or drink.  Hand sanitisers are a great idea for those situations where personal hygiene is compromised by available facilities.

The bacteria can often be found on crockery and cutlery so make sure any dishes, cups or utensils are completely dry before use.  It’s always a good idea too to eat at clean and reputable restaurants.

When it comes to children, don’t let them play or crawl around on floors or put fingers in their mouth.  Be very careful with dummies, bottles or toys that fall on the floor.  If using milk formula, try to use bottled water if possible.  If not, use water which has been boiled for no less than 5 minutes.

With traveller’s diarrhoea estimated to affect between 20-50% of all international travellers, it is best to be prepared.  Consider packing a few over-the-counter “anti-diarrhoea” medications in your suitcase so you don’t have to go looking for a pharmacy if you do fall ill.  At least then you can quickly start treating your symptoms and make yourself a little more comfortable while you wait it out.  If your symptoms don’t subside in a few days or your condition deteriorates, it’s a good idea to seek medical attention.  Got questions?  Why not call us on 1300 819 888 or send us an email


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