What Is Travelers' Diarrhea—And What Should You Do if You Get It?
Vacation is supposed to be a time of rest and relaxation—but a case of travelers' diarrhea can turn your trip into a full-on nightmare.
According to the Centers for Disease Control and Prevention, travelers' diarrhea is the most common travel-related illness; CDC data suggests it can affect 30%–70% of travelers, depending on the destination and season. Though it can technically occur anywhere in the world, it's more common in high-risk destinations in parts of Asia, the Middle East, Africa, Mexico, and Central and South America.
Here, gastroenterologists explain what causes travelers' diarrhea, what the symptoms are, and how best to treat it, so you can enjoy as much of your vacation as possible.
What are the symptoms of travelers' diarrhea?
Travelers' diarrhea is technically a form of acute diarrhea—when stools become loose and watery, suddenly—that comes on while traveling. According to the CDC, there are different levels of travelers' diarrhea (mild, acute, and severe), and they can include the following symptoms at varying severities:
- Mild cramps
- Urgent loose stools
- Severe abdominal pain
- Bloody diarrhea
Depending on the exact cause of the travelers' diarrhea, symptoms can come on within a few hours to as long as a few weeks. The CDC says bacterial travelers' diarrhea can last up to seven days, while viral travelers' diarrhea lasts for about three days.
What causes travelers' diarrhea?
Clinically-speaking, travelers' diarrhea can result from a few different pathogens, the CDC says. The most common cause is bacteria, which may account for about 80%–90% of illnesses, followed by intestinal viruses which can account for 5%–15% of illnesses. Less commonly, travelers' diarrhea is caused by parasites (technically, protozoal pathogens), which are usually slower to manifest, the CDC says.
Poor hygiene practices in vacation destination restaurants is a big risk factor for travelers' diarrhea caused by bacteria—that's largely due to the water supply in the underdeveloped nations where travelers' diarrhea is more common. According to Christine Lee, MD, a gastroenterologist at Cleveland Clinic tells Health, "sewer systems that overflow during heavy rains [and] poorly laid-out pluming," are contributing factors.
The CDC adds that stool contamination in warmer environments, as well as inadequate electrical capacity (which leads to unsafe food storage) may also be to blame. That said, even in developed nations, people can pick up travelers' diarrhea through poor food preparation techniques and lack of proper handwashing.
When it comes to viral causes of travelers' diarrhea, cruise ships are commonly at the root of the issue. "Cruise ships are known for two viruses specifically that spread like wildfire," says Dr. De Latour. The most common viral cause of travelers' diarrhea is norovirus, a highly contagious virus that causes diarrhea and vomiting. Cruise ships help the virus spread because so many people are in such close proximity and, pre-pandemic at least, humans are generally not great at washing their hands before touching their faces, says Dr. De Latour.
One reason is that you simply aren't used to the food or water in the place you're traveling. "There may be different probiotic bacteria that live on lettuce or other foods there that you're just not accustomed to," If that's the case, the diarrhea is about the change in environment, not an infection, and should clear up in a couple of days, she says.
Traveling can also be stressful, especially traveling internationally. So, if you're stressed and you're physically tired after a 12-hour flight, your body might respond with loose, watery stool. Again, diarrhea caused by stress isn't infectious and will get better quickly.
Can you avoid travelers' diarrhea?
It can be difficult to avoid traveler's diarrhea, especially when traveling abroad. On a cruise ship, the best way to avoid it is to watch where you're putting your hands, wash your hands frequently, and avoid touching your face, says Dr. De Latour. You should also beware of buffet lines, where someone carrying norovirus could have touched the food or serving utensils.
When traveling to underdeveloped countries, the best way to prevent traveler's diarrhea is to be careful of what you eat and drink. In the US specifically, citizens are used to pasteurized foods, meaning they've been partially sterilized through heat or irradiation. Sometimes, that's not the case in other countries, "so, getting that exposure to a digestive system that has never had an unpasteurized product...we would be very vulnerable," Christine Lee, MD, a gastroenterologist at Cleveland Clinic tells Health. When traveling, be extra careful to check if something is pasteurized before you eat or drink it.
You'll also want to avoid undercooked meats and seafood. "If you're traveling to an underdeveloped country, that might not be where you want to eat a rare steak," says Dr. Lee. The same goes for sushi made with raw fish or dishes like ceviche or tartare that are made with raw seafood and meat. Although it's not what a cardiologist would want to hear, says Dr. Lee, fried foods are your safest option while traveling anywhere where you're unsure about how safe the water is.
While fruit and veggies—aka, things you don't have to cook—might seem like a safe enough option, they also carry risk, since they could have been washed in contaminated water. In that case, fruit you can peel (think: bananas or oranges) maybe a safer option.
Finally, paying attention to what you drink (and which fluids get into your mouth) is key to preventing travelers' diarrhea, too. Alcohol is considered safe, because it can kill bacteria; sealed drinks (bottled soda, bottled water, bottled juice) are also considered safe as long as they have an unbroken seal. If those options aren't available, boiled water is your next safest bet. And remember: There are other ways contaminated water can get into your mouth—during showering and while swimming, for example. Dr. Lee says you should try your best not to swallow during those times, and to even brush your teeth with bottled water and avoid ice in drinks.
"In general, if you stick to those guidelines, you'll be fine," she says. Although you're at greater risk for diarrhea when you travel, traveling shouldn't be a scary thing. South America, Central America, Mexico, Africa, the Middle East, and Asia offer amazing, enriching experiences worth the risk.
How is travelers' diarrhea treated?
Treatment for travelers' diarrhea depends on the severity of the case. In moderate to severe cases—and if you're able to seek medical treatment—doctors may prescribe antibiotics like azithromycin or fluoroquinolones, the CDC says. Antibiotic treatments, however, are not recommended for patients with mild travelers' diarrhea—in those cases, antimotility agents like loperamide (Imodium A-D), may be used to help relieve diarrhea symptoms.
But for many with travelers' diarrhea, you'll just have to let it run its course and make yourself as comfortable as possible. That means staying hydrated to prevent dehydration, getting lots of rest, and eating smaller meals that are gentler on your stomach. The US National Library of Medicine also suggests eating salty foods (pretzels, crackers, soup, sports drinks), and foods high in potassium (bananas, potatoes without the skin, fruit juices) to help feel better.
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter