The raw egg breakfast at the hawker stall was a culinary adventure—the yolk still slightly runny, the flavors bold and unfamiliar. I savored every bite, feeling like a true foodie explorer. But within an hour, my excitement turned to dread and I wish I had read the traveler’s diarrhea survival guide before my trip.
As I walked to my next sightseeing destination, a wave of nausea hit me. My stomach churned violently. A cold sweat formed on my forehead. And then, the urgent realization: I needed a bathroom. NOW. I sprinted to the nearest restroom, barely making it in time. Relief. But that relief was short-lived. Minutes later, another wave came. And another. My body felt weaker with each episode. My grand day of exploration had been hijacked by traveler’s diarrhea.
If you’ve ever had TD, you know how miserable it can be. If you haven’t, trust me—you don’t want to experience it. But the good news? With the right precautions and this traveler’s diarrhea survival guide, you can avoid the worst of it. Here’s what I wish I knew before my unfortunate encounter.
- What exactly is traveler’s diarrhea
- How do we get traveler’s diarrhea?
- What is most important when you get traveler’s diarrhea?
- How to prevent traveler’s diarrhea?
- Are there medications or vaccines available for prevention?
- Are there medications available for treatment?
- When to get help?
What Exactly Is Traveler’s Diarrhea? (The Unwelcome Travel Companion)
Traveler’s diarrhea (TD), often humorously (but not when you’re experiencing it!) called “Montezuma’s revenge”, “Delhi belly”, or “Bali belly” is the most common illness affecting travelers. It’s characterized by the sudden onset of frequent, loose, or watery stools – typically three or more in a 24-hour period(1). But it’s often more than just diarrhea, TD can bring a whole host of unpleasant symptoms, including(1):
- Abdominal cramps and pain: That twisting, churning feeling.
- Nausea and vomiting: Feeling queasy and potentially throwing up.
- Fever: A sign your body is fighting infection.
- Bloating and gas: Adding to the discomfort.
- Urgency: That sudden, gotta-go-NOW feeling.
Traveler’s diarrhea is usually caused by bacteria, most commonly E. coli, but viruses and parasites can also be culprits(1). It’s your body’s rather dramatic way of trying to get rid of unwanted invaders!
How Do We Pick Up This Unwanted Souvenir? (The Culprits Behind TD)
TD is mostly food and waterborne(1). It happens when you unknowingly consume contaminated food or drinks. The main offenders(1):
🚫 Food Culprits: Risky Foods to Watch Out For
- Street food & hawker stalls – Some are safe, but others don’t follow strict hygiene.
- Raw or undercooked food – Like my runny egg mishap.
- Buffets & salad bars – Sitting food = bacterial playground.
- Unpasteurized dairy – Cheese, milk, and ice cream can be risky.
🚫 Drink Dangers: Risky Drinks to Avoid
- Tap water – In many countries, it’s not safe.
- Ice cubes – Often made from unsafe tap water.
- Unsealed bottled water – Some are refilled with tap water (check the seal!).
- Water-washed fruits & veggies – Bacteria can linger on the surface.
High-risk regions include Asia, Africa, Latin America, and the Middle East, but even “safe” destinations can have risks(1).
What Is Most Important When You Get Traveler’s Diarrhea?
🚨 #1 Rule: Stay Hydrated!
TD depletes your body’s fluids and electrolytes fast—and dehydration can be dangerous. Here’s how to stay ahead of it(1,2):
💧 Best Hydration Options:
- Oral Rehydration Salts (ORS) – The gold standard (brands: Hydralyte, Pedialyte).
- Clear broths & soups – Gentle on the stomach and replenishes sodium.
- Diluted sports drinks (Gatorade, Powerade) – Okay in mild cases, but high in sugar.
- Weak tea – Can be soothing.
- Plain water – Not enough on its own; pair with electrolytes.
🚫 Drinks to Avoid:
- Sugary sodas & juices – Can worsen diarrhea.
- Alcohol & coffee – Dehydrates you more.
- Milk & dairy – Can worsen symptoms (temporary lactose intolerance).
Pro Tip: Carry ORS packets or dissolvable ORS tablets in your travel first-aid kit.
Traveler’s Diarrhea Survival Guide: Your Shield Against TD
How to Prevent Traveler’s Diarrhea?
Being proactive about food and water safety can drastically reduce your risk. Practice the following precautions(2):
- 💡 “Boil It, Cook It, Peel It, or Forget It” – The golden rule of food safety abroad.
- Safe Drinking Tips:
- Bottled, sealed water – Always check the seal!
- Boil tap water for at least 1 minute (3 minutes at high altitudes).
- Use water purification tablets or a UV filter.
- Skip the ice cubes (unless you’re sure they’re made from purified water).
- Use bottled water to brush your teeth.
- Keep your mouth closed in the shower to avoid swallowing water.
- Smart Eating Habits:
- Eat at busy food stalls – High turnover = fresher food.
- Opt for steaming hot, freshly cooked meals.
- Check hygiene – Do vendors wear gloves? Is the prep area clean?
- Avoid raw salads & unpeeled fruit – Likely washed in tap water.
- Beware of buffet food – If it’s been sitting out, skip it.
Are There Medications or Vaccines For Prevention?
- Bismuth Subsalicylate (Pepto-Bismol, Gastrovol):
- Adult dose: Two 262mg tablets four times daily seems to provide a 50% to 65% protection rate(3,4)
- Dukoral (oral vaccine for Cholera and Enterotoxigenic Escherichia coli (ETEC) which is the most common cause of traveler’s diarrhea)(currently not available in US, available in Canada)(5):
- Dose for 2 years and older:
- 2 doses 2 weeks apart
- First dose at least 2 weeks before departure and second dose at least 1 week after 1st dose
- If more than 6 weeks between first and second dose, the 2 doses have to be repeated
- According to the manufacturer, Dukoral had an 86% protective efficacy against clinically severe ETEC traveler’s diarrhea(5)
- However, as most cases resolved on their own within a few days(2), the Canadian Immunization Guide finds that the overall protection of Dukoral against traveler’s diarrhea is approximately 6%(6).
- Dose for 2 years and older:
- Antibiotics for prevention: not recommended for most travelers due to risk of resistance(4).
Are There Medications Available For Treatment?
- Oral Rehydration Salts (Hydralyte, Pedialyte): the ratio of electrolytes (salts) that is needed for our body to recover or prevent dehydration(7).
- Loperamide (Imodium): slow the movement of the intestines which allow fluids and salts to be absorbed back to the body and minimizing diarrhea output(8).
- As per Imodium Canada, dose for adults and children 12 years and older:
- 2 capsules as first dose, then 1 capsule after each bowel movement. Max 8 capsules per day(9).
- As per Imodium Canada, dose for adults and children 12 years and older:
- Antibiotics: antibiotics may be effective in decreasing the duration of traveler’s diarrhea by 1 to 2 days if the cause of the diarrhea is bacteria based and sensitive to the antibiotic taken(4). However, drug resistance and the affect on the individual’s ‘good’ bacteria are concerns(4).
- Common antibiotics used include:
- Azithromycin: 1000mg as a single dose or 500mg once daily for 3 days(4).
- Ciprofloxacin/Levofloxacin: increasing resistance especially in South and Southeast Asia(4).
- Levofloxacin: 500mg once daily for 1 to 3 days(4).
- Ciprofloxacin: 750mg as a single dose or 500mg twice daily for 3 days(4).
- Common antibiotics used include:
When to Seek Medical Help: Don’t Delay!
Don’t hesitate to consult a doctor or local healthcare professional if you experience any of the following “red flag” symptoms(4):
- Severe dehydration: Signs include:
- Decreased urination or very dark urine.
- Dizziness or lightheadedness, especially when standing up.
- Dry mouth and skin.
- Rapid heartbeat.
- In children and infants: sunken eyes, dry mouth, listlessness.
- Bloody stools: Could indicate serious bacterial infection (dysentery).
- High fever: Temperature over 102°F (39°C) or persistent fever.
- Severe abdominal pain: Intense, persistent pain, not just cramps.
- Diarrhea lasting longer than a few days (more than 3-4 days) without improvement.
- Inability to keep down fluids (persistent vomiting).
- Signs of worsening symptoms despite self-care.
- Underlying health conditions: If you have pre-existing conditions like diabetes, heart disease, inflammatory bowel disease, or a weakened immune system, seek medical advice sooner rather than later.
- Infants and young children: Dehydration can be more dangerous for them, so seek medical advice promptly if they develop diarrhea.
💡 Where to Get Help Abroad:
- Local clinics or hospitals (ask your hotel for recommendations).
- Your travel insurance helpline.
- Your embassy/consulate (for medical referrals).
Don’t be afraid to seek medical help! It’s always better to err on the side of caution and follow the traveler’s diarrhea survival guide, especially when you’re in an unfamiliar place. A healthcare professional can properly assess your condition, rule out more serious issues, and recommend the most appropriate treatment. Besides Traveler’s Diarrhea, other disease transmitted through food include Hepatitis A and Typhoid. Don’t forget your travel vaccines!
Found this guide helpful? Share it with your fellow travelers to help them stay healthy on their next trip!
Disclaimer
The information provided on this blog is for general knowledge and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Medications and/or vaccines mentioned in this article is not suited for everyone. All medications can contain side effects, contraindications and interactions, check with your pharmacist or healthcare provider if it is suitable for individual needs.
References
(1) https://www.canada.ca/en/public-health/services/diseases/diarrhea.html
(2) https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/food-and-water-precautions
(3) https://www.aafp.org/pubs/afp/issues/1999/0701/p119.html
(4) https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea
(5) https://dukoralcanada.com/dukoral-dosing-administration/
(7) https://travel.gc.ca/travelling/health-safety/rehydration
(8) https://www.imodium.com/anti-diarrhea-medicine/how-imodium-works