Traveler's Diarrhea : What To Do (And Not To Do!)


By Yulli Agnes, MD, MBiomed (AAM)

Travelers’ diarrhea is a very common travel-related health problem in Bali. Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhea, nor is the passing of loose, "pasty" stools by breastfed babies (WHO). 

Diarrhea is usually a symptom of an infection in the bowel by a variety of bacterial, viral or parasite. By experience, the most common causes of infectious diarrhea in Bali are by Escherichia coli, Giardia & Entamoeba hystolitica. Rotavirus is common in children. Common symptoms that come with diarrhea include nausea, vomiting, abdominal cramp, fever.

Infection is spread through contaminated water & food, or from person-to-person as a result of poor hygiene. It is more common when there is a shortage of adequate sanitation and hygiene, and safe water for drinking, cooking and cleaning.
Water contaminated with human or animal feces can further contaminate food during cleaning & preparation. Fish & seafood from contaminated water, and food stored in unhygienic conditions also contribute to the risk of infection. Insects and bugs can transmit diseases by transferring organism by contact with foods. For example, the common housefly can spread human bowel infections, such as typhoid, bacillary and amebic dysentery, by contamination of food as it lands on foods after previously "walking" on contaminated items like feces.

Key measures to prevent diarrhea include:

  • Safe drinking-water/beverages & food hygiene.
  • At best, drink boiled or bottled water & beverages
  • Use ice cubes made from boiled or bottled water.
  • Do not drink tap or well water.
  • Be cautious with raw or under cooked food (salad, pre-peeled fruits, under cooked eggs, meat, fish, shellfish).
  • Avoid food from street vendors.
  • Be cautious when you spot some common housefly flying around the eatery.
  • Use of improved sanitation & good personal hygiene.
  • Hand & utensils washing with soap or alcohol-based hand sanitizers (containing ≥60% alcohol) 

If you have diarrhea : 

  • Do NOT take Imodium (Loperamide), especially if you have bloody diarrhea and/or fever; it will slow the movement of the bowel muscle, while it may reduces the bathroom trips, the germs will stay inside the bowel instead of getting out.          
  • Activated charcoal tablets, to prevent toxin absorption in the bowel.  
  • Psyllium seed powder, to absorb water from stool & soothe intestinal lining (do not use within 1 hour of taking other medications).  
  • Probiotic, to help balancing the gut flora. 
  • Drink plenty of liquid, as diarrhea causes water & electrolyte loss. Coconut water is a good option as it contains electrolyte. Rehydration salts solution, is a mixture of clean water, salt and sugar; Rehydration powder, canned & bottled electrolyte water are easily available over the counter in Bali. 
  • Avoid caffeine, alcohol, and dairy products, as they could worsen your condition.
  • Avoid high-fiber foods, which may stress the bowel even more. Take foods that are easy to digest, properly cooked and not spicy.

If you have nausea, vomiting and mild abdominal pain :

  • Herbal tea such as ginger, clove, peppermint or fennel seed, may help relief the symptoms.
  • Essential oil such as peppermint, lavender, patchouli or ginger; by inhalation, or massaging behind ear and over the navel, may help relief the symptoms.         

Immediately consulting with health professional, in case of :

  • Blood and/or mucus in stool.
  • Uncontrolled /severe vomiting.
  • Severe abdominal cramp.
  • High fever.
  • Signs of dehydration.
  • Persistent diarrhea (≥ 14 days).

Depends on the severity, risks and personal choices, some herbs with antibiotic and immune booster properties may be use to treat infectious diarrhea. However, some conditions could be severe & may cause serious problem, and in this situation a direct & quick approach will be offered & given if the client prefer to have one.   

*Disclaimer : The information contained in this website is intended to give information only. It is not intended to replace the advice of a health care professional. If you have questions or concerns about your health, please see your health care provider.