Young Caucasian girl sat on the toilet as her mum stands by the door and watches over her.

What is it and what are the symptoms of traveller's diarrhoea?

By Cristiano Antonino On Dec 27, 2022

Traveller’s diarrhoea is one of the most frequent diseases that can occur in those who choose to travel to exotic destinations and developing countries such as, for example, Africa, the Middle East, Asia, Latin America

Countries and cities in which there may be poor hygienic conditions or whose inhabitants have different habits and lifestyles to those of the individual traveller.

According to the Istituto Superiore di Sanità (ISS), it is estimated that around 80% of travellers could be exposed to episodes of diarrhoea during a holiday abroad or on their return. Let’s see how to recognise and treat it.

Traveller’s diarrhoea, how the infection occurs

Traveller’s diarrhoea cannot be transmitted in the same way as a cold, i.e. directly through particles emitted by breathing, but is essentially transmitted by ingesting food or drink contaminated with the germs responsible.

The main symptoms of traveller’s diarrhoea are the evacuation of liquid or semi-liquid stools and an uncontained urge to evacuate 3 to 5 or more times a day

Other symptoms concomitant to the evacuations are:

nausea;
abdominal cramping and bloating;
vomiting;
fever;
malaise;
dehydration;
malabsorption of food.

In particular cases, mental confusion/spatial/temporal disorientation may also occur in those who have been suffering from traveller’s diarrhoea for days.

The duration of traveller’s diarrhoea is variable: from a minimum of 2 days to a maximum of 7-10 days. In some cases, however, it may be prolonged.

Causes of traveller’s diarrhoea

Water is among the main culprits of this intestinal disorder that can develop into a disease if not treated properly.

In some territories, the water used to prepare food and drink is not infrequently contaminated with microparticles of faeces or waste water from sewers or animal farms, which contain Escherichia coli, a bacterium found in human or animal faeces that can cause traveller’s diarrhoea, or other pathogens (viruses and protozoa).

Who it affects

Traveller’s diarrhoea is a disease that affects the intestines of men and women indiscriminately, but more frequently it is the more fragile who suffer from it: the elderly, children, people with previous illnesses (e.g. diabetic patients, patients suffering from inflammatory bowel disease, immunocompromised patients or patients being treated with antacids, etc.).

Among the tourist destinations that most expose the Western traveller’s intestine to diarrhoeal episodes are exotic destinations and developing countries.

The reason for this is the following causes:

lack of drinking water;
different habits: behavioural differences in hygiene and food handling;
poor prevention on the part of the ‘do-it-yourself’ or inexperienced traveller: little or no adherence to the travel advice offered by the Travel Medicine Services of accredited public or private institutions, travel agencies and tour operators specialising in travel to non-EU countries.

How to treat traveller’s diarrhoea: medication yes or no?

Generally speaking, no drugs are needed to treat diarrhoea, which resolves on its own in a couple of days.

If it does not stop, the treatment depends on the symptoms and the duration of the diarrhoeal events.

The basic treatment is hydration in small sips, because a lot of fluid is lost with diarrhoea; it may be useful to supplement hydration with mineral salts and water of certain, controlled origin.

In adults, during the first two days it is useful to combine hydration with the intake of symptomatic drugs (pharmaceutical preparations to treat symptoms, ed.) for:

reduce the number of discharges (loperamide-based anti-diarrhoeics)
compensate for the loss of electrolytes, especially potassium, that occurs when diarrhoea is profuse.

In the event that symptomatic drugs alone do not lead to a reduction in discharges, it is useful in adults to combine an antibiotic, such as levofloxacin or azithromycin, under medical supervision from day three.

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10 useful tips to prevent it

Reducing the risk of contracting traveller’s diarrhoea requires special attention to what you eat and drink, as well as certain behavioural rules.

Here are the main health allies and useful tips for preventing traveller’s diarrhoea:

wash your hands frequently, especially before touching food and drink; dry them using the air dispensers in the toilets or in the air rather than using the paper or cloth towels that may be available to guests and for mixed use. After washing hands, sanitise them with hydro-alcoholic solutions before touching your mouth, nose, eyes and food.
Only drink water and other drinks if they come from sealed bottles or in the case of water if it has been boiled and thus rendered sterile.
Do not consume ice: when ordering drinks ask for them without ice (for prevention there is no need to remove the ice because then cross-contamination has already taken place). Ice lollies and slushies, sorbets and ice cream can only be consumed if they are industrially produced and purchased in unopened packages (not served loose).
Do not eat fruit with the peel on, and only wash it with sterilised water (brought to the boil at 100°) or from sealed water bottles after having cleansed and sanitised your hands.
Do not eat raw vegetables and meat: instead of salads and cold cuts or cheese, prefer vegetables, meat and fish that are well steamed, grilled or fried.
Prefer cooked and very hot food to food served at room temperature: heat helps prevent the proliferation of parasites, viruses and harmful bacteria that may be present in food or on food and dishes exposed to the air (often without any protective barrier).
Avoid street food or choose fried street food. Especially if the frying takes place when the food is purchased, the high temperatures of the oil will offer better guarantees of the healthiness of the food than if the food is pre-cooked and reheated or served lukewarm/cold.
Pack a first-aid kit with anti-diarrhoeal and anti-nausea medicines, as well as mineral supplements.