Learn about symptoms and causes of traveller's diarrhoea, self help treatment options, medication and when to seek medical help.

What is Traveller’s Diarrhoea?

Diarrhoea happens when you pass out loose, watery stools with an increase in bowel movement to three or more times a day. It is known as traveller’s diarrhoea if it happens when you are travelling overseas. Traveller’s diarrhoea is the most common travel-related illness, affecting 20% to 60% of travellers around the world. It can occur to anybody, especially in places with poor hygiene.

Traveller's diarrhoea usually gets better on its own within two to three days. In healthy adults, it seldom harms a person's life, but it can affect you from enjoying your holiday.

What are the possible causes of this condition?

Traveller’s diarrhoea may be caused by consuming food or water that contains bacteria, viruses or parasites. Some examples of these include:

• Unhygienic handling of food and lack of clean water.
• Buying food and drinks from street vendors and eating at places with poor hygiene.
• Taking drinks with ice made from unclean water.
• Not washing your hands well with soap and water after using the toilet.
• Eating on unclean surfaces (e.g. table) or using unclean utensils (e.g. spoon, fork, chopsticks).

There are some factors that may increase your chances of getting traveller’s diarrhoea:

• If you have a weak immune system due to reasons such as illness, poor nutrition or old age.
• If you use certain medications regularly, such as medicines that reduce stomach acid (e.g. antacids, omeprazole) and medicines that lower your immunity (e.g. oral steroids, certain cancer medicines).

What are the symptoms of Traveller’s Diarrhoea?

If you have traveller’s diarrhoea, you may have the following symptoms:

• Loose watery stools
• Three or more bowel movements a day
• Stomach cramps
• Nausea and/or vomiting
• Fever
• Bloatedness
• Dehydration (loss of too much water from the body) due to diarrhoea. Signs of dehydration include:
  • Dry mouth
  • Drowsiness or feeling tired
  • Feeling thirsty
  • Passing less urine than usual
  • Dry skin
  • Headache

Diarrhoea may occur anytime from a few hours to a few weeks after you have taken unclean food or water. 

What can I do to treat Traveller’s Diarrhoea?

Traveller’s diarrhoea usually gets better on its own, but it may be treated with these medicines:

• Anti-diarrhoeal (e.g. loperamide, diphenoxylate) to reduce the number of bowel movements.
• Anti-spasmodic (e.g. hyoscine, alverine, dicyclomine) to reduce stomach cramps and pain.
• Anti-flatulent (e.g. simethicone) to relieve bloatedness.
• Dioctahedral smectite (Smecta) that protects your gut.
• Oral rehydration salts to replace the water, salts and sugars that your body loses due to diarrhoea. 

When do I need to see a doctor?

Although traveller’s diarrhoea can be treated without seeing a doctor, there are times where the condition may be more serious. You should also see a doctor if you experience any of the following:

• Symptoms do not become better or become worse after 24 hours of self-treatment.
• Vomiting that does not get better or becomes worse.
• Not able to keep water or other liquids down.
• High fever of 38.5^oC or higher.
• Blood in stools or vomit.
• Very bad dehydration. Symptoms include: feeling very thirsty, not passing urine, not sweating, fast heart beat, flushed (red) skin, muscle cramps and confusion.

The elderly, young children and people with long-term illnesses who have diarrhoea with high fever, or blood in their stools should see a doctor immediately.

What else can I do to manage this condition?

You should drink plenty of water or oral rehydration salts to replace the water lost from the body. If possible, stay away from others and avoid sharing food or utensils for at least 48 hours after the last loose stool to prevent spreading any infection to others.

Antibiotics should only be used if bacteria are the cause of traveller’s diarrhoea. They do not help with diarrhoea caused by viruses and parasites. Do not take antibiotics unless instructed by your doctor, as doing so can increase the risk of bacteria becoming resistant to antibiotics.

The following are some suggestions to prevent traveller’s diarrhoea from happening again:

• Wash your hands regularly. Wash your hands with soap and water before eating. If there is no soap and water, use hand sanitisers instead.
• Drink water that has been boiled, or bottled water.
• Drinks such as coffee or tea should be made with boiled water.
• Use water that has been boiled to brush your teeth.
• Do not take drinks with ice as the ice cubes may have been made with unclean water. Use only bottled or boiled water for ice cubes.
• Do not eat raw or undercooked meat and seafood. 
• Eat only fully cooked food that is served while it is still hot. Avoid food that has been left to cool for some time.
• Fruits should be peeled and washed in bottled or boiled water before eating.
• Do not eat food and drinks bought from street vendors.
• Do not eat raw vegetables (e.g. salads) and milk products unless you are sure that they come from clean and hygienic sources.

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.