Traveler’s diarrhea: Coping with the runs on the run

by Alan M. Spira, M.D. (Second of two parts)

In the last issue I discussed the dreaded runs and how to decrease your chances of catching traveler’s diarrhea.

There is a fairly good chance your digestive system will act up when you travel. Most cases of traveler’s diarrhea are benign; that is, while distressing, they are not serious. However, some cases can turn serious and threaten not just your journey but your health. Dysentery occurs if blood or mucous is in the stool, and you may also have a fever. Cholera is an intense watery diarrhea with flecks of mucous (like rice water), which can dehydrate you rapidly.

In general, if you have diarrhea and feel well, don’t stress. This is likely just “adjustment diarrhea.” In this case, rehydrate with lots of water and take some Imodium.

How do you know you are adequately hydrating? By your urine! Don’t rely on thirst. By the time you are thirsty, you are already behind and will have to catch up. The best gauge is how often and what color your urine is.

You should be able to readily urinate every four to six hours, and it should be the color and clarity of water. If it is dark, turbid, fluorescent or foamy, you need to drink more water until you have clear and frequent urine.

If you have diarrhea and feel sick, then you need to deal with it quickly. You are the master of your body, and so you judge whether or not you are feeling “sick.” Anything that you think is “sick” qualifies, whether it’s nausea, vomiting, cramps, fever or dizziness, etc.

If you have diarrhea and feel sick, you need to attack the problem right away. The two most important things you can do are 1) hydrate adequately and 2) take Oral Rehydration Salts (ORS).

ORS come in standard packets and should be added to the water that you drink. They are badly named, and so people don’t taken them seriously. They are not really salt but electrolytes and minerals in the correct ratio that you need to recover. In fact, the World Health Organization stands behind just these two actions as being the mainstay therapy for cholera.

You could also consider antimotility agents, such as Imodium, which slow down the motion of the intestines. Do not take them if there is blood in your stool or you have a fever; you could turn your infection more dangerous. Stick to a bland diet and avoid anything that provokes more symptoms, such as coffee, caffeinated tea, chocolate or fried foods.

Antibiotics may be necessary. These are prescriptions to kill bacteria (special medicines are needed for protozoal causes) but not diarrhea from viruses (a common cause) or food toxins.

It is not as simple to choose an antibiotic as it once was. Formerly, Cipro was king, but the worldwide abuse of antibiotics has led to the elimination of weak bacteria so that tougher germs circulate which have developed resistance to Cipro and other drugs. The resistance patterns vary throughout the world, so consulting with a specialist in travel medicine is truly important while planning a trip.

Do not take antibiotics just because you expect diarrhea! Take them only when you have diarrhea and feel sick. The exception is rifaximin, which stays in the intestines only, but it does not protect against the dangerous invasive bacteriae of dysentery and sepsis.

You should get medical care if. . .

  • you don’t get better with the above advice, or you get worse;
  • the vomiting and/or diarrhea lasts more than three days;
  • there is blood, mucous or worms in your stools — and if you have fevers — and
  • you are light-headed, extremely weak or cannot keep any liquids down.

With some intestinal infections, there can be an unfortunate complication: a persistent change in the intestinal function which may last weeks to years in some cases. This is a post-infectious malabsorption syndrome and can be due to low-grade persistent infection or to the damage left behind from the infection even though the germ may be long gone. This requires specialist care, as most physicians do not seem familiar with this issue from traveler’s diarrhea.

A travel medicine specialist will know about any disease outbreaks around the globe, what precautions to take and which vaccines to recommend. Before your next trip, you can find a list of such specialists online at and

Healthy travels!

Dr. Spira is medical director of the Travel Medicine Center, 131 N. Robertson Blvd., Beverly Hills, CA 90211; visit