March break Traveller’s Diarrhea and IBS flare up-Prevention
It is finally springtime, plans made, resort booked, airline tickets purchased, bags getting packed. Finally, you can hit the beach, and sunshine after a two-year hiatus. So exciting! A glorious week of sun, relaxing, exploring awaits. Nothing must go wrong. One more detail, IBS is coming along on the trip. Keeping your IBS under control will ensure a happy vacation.
It’s common for IBS flareups to occur when travelling because of factors including change in routine, time change, food, and stress.
With a mere week to enjoy, no one wants to find their trip disrupted with an IBS flare up leaving you only memories of the bathroom and bedroom. Being prepared and organized will help prevent flare ups through mitigating anxiety for starters. Checking out the food at the resort, sticking to your routine, watching how much alcohol you drink, keeping active on the trip. Remember to bring along your probiotic, and a prebiotic like Metamucil®.
Southern shores of some countries are enticing with fine sand beaches, palm trees, warm Caribbean waters, sunshine and great food. However these places also come with risk of in the form of Traveller’s Diarrhea. Anyone with IBS is aware of the impact of upsetting the delicate balance of the gut microbiome. An intestinal infection will send your IBS into a severe flare up disrupting that highly anticipated vacation.
What is Traveller’s Diarrhea?
Traveller’s Diarrhea (TD) is an infection of the gastrointestinal system caused by bacteria, such as E. coli, Salmonella, Shigella and Campylobacter, parasites Giardia, Crytosporidium, Cyclospora and viruses like norovirus and rotavirus. The bacteria, parasites and virus that cause TD are found in running water in undeveloped countries which do not have good water purification systems. TD is spread by eating food or drinking water that is contaminated, or from person to person due to poor hygiene. It is estimated that 10%-40% of travellers to developing countries become infected with TD. The most common cause is E.Coli in the water.
What are the symptoms?
Symptoms of TD generally gastrointestinal, including nausea, vomiting, bloating, abdominal cramps, fever and diarrhea. Diarrhea is 3 or more loose watery stools per day. Severity of symptoms varies from person to person, where severe diarrhea can lead to dehydration and possibly death. Generally the symptoms can be short lived, a few days and self resolving. However in person’s with IBS the severity will be aggravated.
Preventing Traveller’s Diarrhea:
The best way to prevent Traveller’s Diarrhea is to avoid contaminated water, drinking or eating foods washed with the water. When it comes to fruit and vegetables, remember this phrase ‘Boil it, cook it, peel it or leave it!’ If staying in a resort, you might want to enquire if they have filtered water to wash the vegetables and fruit served fresh, as well as bottled water in rooms to drink and brush teeth. If renting house, always boil the water that you will be using to clean your fresh produce.
Tips on preventing ingestion of contaminated water:
Always wash your hands before eating or preparing food remember to wash your husing the bathroom, changing diapers, or having contact with animals or sick people. Bring along alcohol based (70%) hand sanitizer.
Only eat foods that are well cooked and served hot.
Avoid raw or undercooked (rare) meats and fish, including shellfish.
Only eat fruits and vegetables washed in safe water or you peeled
Avoid salads, or other items that are made with fresh produce and you are not certain of the water used for cleaning.
Do not eat food from street vendors.
Drink water only if it has been boiled or disinfected or is in a commercially sealed bottle.
Make sure all ice cubes are made of water that is purified.
It is safe to drink hot steaming drinks like coffee and tea, as well as all commercially available drinks in sealed bottles or cans
Brush your teeth with purified or bottled water
Avoid unpasteurized dairy products and fruit juices.
Probiotics like Florastor® can help in the prevention of Traveller’s Diarrhea. Studies of the impact of Florastor® containing probiotic strain, Saccharomyces boulardii, ] demonstrated in clinical trials to be effective in preventing Traveller’s diarrhea.
You can also vaccinate against E.coli caused Traveller’s Diarrhea before you go! Dukoral® is an oral vaccine that protects against a form of E. Coli (LT-ETEC), and Cholera. Dukoral® is indicated for people 2 years of age and older. Dukoral® should be taken TWO WEEKS prior to departing on your trip. First dose is taken two weeks prior, and second dose one week before leaving on the trip to get full vaccination. For children 2-6 years of age, they require three doses, to start three weeks prior to trip. Dukoral® can be purchased with or without a prescription in most parts of Canada, except Quebec where a prescription is required. For a family of four , where the children need three doses the total cost is around $500. If you have a drug plan, check to see if Dukoral® is covered.
Vaccinating with Dukoral®, using good hygiene practices and avoiding contaminated water is the best way to ensure a healthy vacation free of Traveller’s Diarrhea.
How to Manage Traveller’s Diarrhea
Most symptoms clear up on their own after a few days, with the most important measure is to maintain good hydration with bottled water or oral rehydration solutions like Gatorade®
For severe diarrhea you may need anti-motility medication like Imodium® which slows down the movement of bowels and prevents dehydration. However if there is blood in the stool or you have a fever, do not use Imodium®. Pepto-Bismol® is recommended to help decrease diarrhea by re absorbing the water, and adsorbing the bacteria/virus causing the infection. Consult with your primary health care providers, physician or pharmacist as to which option is best for you.
You can also speak to your doctor about a prescription for an antibiotic to take to treat the infection.
When travelling by airplane, remember to carry on all medication that you need to keep healthy. If you have a medication that may be a painkiller, ask your pharmacy for a copy of the prescription. Persons carrying narcotic/controlled substances to other countries may be detained at the border if they do not have proof of prescription. Remember to keep to your IBS routines, watch your trigger foods, be active with swimming and walks on the beach, hydrate and follow tips for preventing Traveller’s Diarrhea.
Packing checklist for carry on luggage:
- Medication you take regularly
- Handsanitizer
- Pepto Bismol
- Imodium
- Antibiotics
- Probiotics- Florator®
- Prebiotic
- Gut friendly snack
References:
Parry S, Forgacs I. Intestinal infection and irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2005;17:5–9.Alexander KC Leung, Amy AM Leung, Alex HC Wong, Kam L Hon. Traveller’s Diarrhea: A Clinical Review. Recent Pat Inflamm Allergy Drug Discov. 2019, May; 13(1): 38-48.https://travel.gc.ca/travelling/health-safety/food-waterProduct Monograph Dukoral Product Monograph Pepto Bismol Product Monograph ImodiumLynne V McFarland. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis 2007 Mar;5(2):97-105.Product Monograph Metamucil