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Delhi Belly?

April 27, 2016

Delhi Belly? Montezuma's Revenge?  Rangoon Runs?

When on holiday you suddenly feel your insides churning and the anxious and URGENT desire to locate a toilet, then you have probably succumbed to Traveller’s Diarrhoea. Whilst the butt (sorry) of many jokes, Traveller’s Diarrhoea is a truly miserable condition that wreaks havoc with many holiday makers. For those who enjoy travel it is useful to know about Traveller’s Diarrhoea, how to try and prevent getting it and how to treat it.

Traveller’s Diarrhoea is the collective name given to stomach and bowel infections acquired during travel. It is acquired from contaminated food or water and can be bacterial, toxin related, viral or parasitic in origin. It may start during travel or shortly after your return home. It can be acquired anywhere in the world, but is notorious in Latin America, India and anywhere where there is poor sanitation and hygiene.

Symptoms can vary but often include churning abdominal pains, frequent loose or explosive stools, excess gas, bloating, nausea and vomiting. Often the diarrhoea can start so suddenly that embarrassing accidents can occur, and the colloquial term, to shart, describes the unfortunate combination of loose stool and lack of anal control when passing wind.

Normally Traveller’s Diarrhoea lasts a few days, but occasionally can persist for weeks. If it is mild it is possible to continue sightseeing but when severe it is impossible to leave the toilet for any length of time, and the thought of a bus ride or a flight can trigger massive anxiety for good reason.

Prevention of Traveller’s Diarrhoea

Prevention is a good policy and simple measures can make a big difference.  Hand hygiene is very important, and if soap and clean water are not available then use hand sanitiser frequently. There are good anecdotal reports of ample use of hand sanitiser dramatically reducing the incidence of Traveller’s Diarrhoea. In addition, ensuring that plates, cups and cutlery are clean is highly advised. One professor of travel medicine highly recommends using antibacterial wipes on the tray table on airplanes.  Never drink out of a can of drink or a bottle without giving it a clean around the part where you are going to put your mouth, or use a straw. Avoid ice in drinks and choose bottled and sealed drinks (beware the common practice of drink bottles being refilled and sold again) over those made with local water. Do not clean your teeth with tap water – use bottled. “Boil it, cook it, peel it, or forget it,” is generally good advice. Resist the urge to dig into a beautiful platter of chopped up fruit, but peel your own. Avoid salads and keep away from shell fish (particularly if you are inland). Street food is often blamed – however at least with street food you can make a judgment about the hygiene standards of the chef as you witness all the food preparation. When in doubt, a dish that has been freshly deep fried or boiled may be a safer option than a cold dish.

Antibiotics are not recommended for prevention of Traveller’s Diarrhoea, because of resistance issues. Bismuth subsalicylate (Pepto-Bismol) provides a rate of protection of about 60 percent against Traveller’s Diarrhoea. However, it is not recommended for persons taking anticoagulants, allopurinol or aspirin. Because bismuth subsalicylate interferes with the absorption of doxycycline, it should not be taken by travellers using doxycycline for malaria prevention. Travellers should be warned about possible reversible side effects of bismuth subsalicylate, such as a black tongue, dark stools, and tinnitus. Pepto- Bismol is not available for sale in New Zealand but is readily available for small change in many parts of the world, and is commonly sold as an indigestion remedy.

Treatment of Traveller’s Diarrhoea

If you do end up with symptoms it is a good idea to be prepared in advance so that you can manage it without having to track down a doctor or pharmacy. If you come to a Medplus travel clinic you will likely be offered some prescriptions for the medications listed below, so that you can be well equipped for your adventures.

Loperamide capsules can be very useful in supressing diarrhoea. However, in mild or short episodes it can feel more comfortable to let it all out rather than holding it in with loperamide.Preventing the passage of stools will only keep a bacterial infection and its poisons inside the body for longer. Loperamide is useful particularly when you do not have the luxury of staying in the close vicinity of a toilet until the diarrhoea has cleared.

A real essential for any traveller are sachets of oral rehydration salts, to make up with (bottled) water to help prevent dehydration with vomiting or diarrhoea.  A mistake many make is to avoid drinking, because they think it exacerbates the vomiting or diarrhoea. Whilst some of any drink may pass back out quite quickly, some of it will be retained to help replenish your losses.  Diarrhoea cannot kill you but dehydration can, so it is really important to consume enough fluid to ensure you are passing urine at least every 4 hours. Water is not absorbed from an ill gut nearly as quickly or effectively as sugary salty water, so oral rehydration salts are ideal. The concentration of salt and sugar has to be just right for them to be effective, sugary drinks like fruit juice, powerade, cola or lemonade can make diarrhoea worse, although are better than nothing. Tablets to reduce nausea and vomiting, such as ondansetron and metoclopramide are useful to help you keep fluids down.

Bismuth subsalicylate (Pepto-Bismol) can also be used to help treat Traveller’s Diarrhoea as well as preventing it.

If the diarrhoea is particularly bad or persistent it is worth trying some antibiotics such as norfloxacillin or azithromycin. However, these should not be used if you have a high fever or bloody diarrhoea, in which case medical attention should be sought.

Medplus Travel Clinic

If you are travelling overseas and need advice, medications, vaccinations or malaria prevention please book to be seen in our nurse led travel clinic. You will be asked to fill out a questionnaire about your travel plans prior to being seen and will require an extended appointment, which will include both doctor and nurse time.  Please book this as soon as you plan your trip, as some vaccination courses can take 6 months to complete.  You may find the following website a useful source of information about Traveller’s Health