Note – Yeah, I know you probably don't want to read about this topic. But the thing of it is, no one talks about this except for travelers on the road when we all share poo stories over a few beers. But that doesn't do much good for folks who are facing a runny tummy and have no clue what to do. Or for the soon-to-be-travelers who are worried about getting sick on the road. So, for all of those fine folk, I'm going to step right into it. This topic, I mean.
Delhi Belly. The runs. Montezuma's revenge.
If you're thinking about traveling internationally, then you've most likely come across references to the glory of traveler's diarrhea. Usually it's mentioned in the handy health section in the back of most guidebooks. You know the section that scares the living shit (so to speak) out of you with tales of every nasty infection, disease, fungus, and run-of-the-mill cold you can get in a foreign country? Don't worry, though. Out of most of the things listed in the health section, a runny tummy isn't all that bad. Well, most of the time.
As previously mentioned, when you travel internationally there is a chance that you will become sick with (what Tim and I are fond of calling) the traveler's woe. Of course where you're traveling to, how long you'll be on the road, and your habits along the way will increase or decrease your risk of getting sick. But even if you travel in a bubble, one day you will come in contact with the bacteria that makes a tummy rumble. If you accept that as fact up front, you'll be less disappointed later on during the days you spend more time on the toilet than on the tour bus.
(And my fingers are crossed that if you are spending time on the toilet, it's not on a bus. I can personally testify that having traveler's woe while going back and forth along the switchbacks of the Andes mountains in Peru isn't a fun experience.)
Now even if you follow our previous advice for staying healthy, you're still going to get a runny tummy at some point. It will involve repeated and lengthy trips to the bathroom. It might involve a few accidents. Your stomach will cramp from time to time. You might have body aches, bloating, or nausea. And (skip this next sentence if you get grossed out easily) it will feel like sewer water is rushing out of your ass. (I wish I was lying about that part, but I'm not.) You will be very unhappy. And you might even puke a few times too.
It won't be pretty. It won't be pleasant. And depending on how bad you have it, it can last a few days or over a week. (I've had it for only one day before, Tim has had it for nearly two weeks before.) But you can make it a bit more comfortable on yourself at the onset of your symptoms and during your days with traveler's woe. Thus, what follows are some tips we learned out of necessity and on the fly (or the throne, I suppose I should say) during our travels. I'm not a doctor, nor do I play one online, so take our tips with that in mind and do whatever feels best to you. But our hope is that our (unfortunately extensive) research will provide you a modicum of comfort when Montezuma comes knocking at your stomach's door.
Yes, I know I sound like I'm 8 years old by using the word fart in a travel post. But we all fart. It's healthy. Sure it might not be polite to do so in front of others, but it happens. And when you're eating all sorts of new foods, farting is your body's way of letting go of the excess gas building up in your stomach.
Farting is like our very own safety valve. Except when you're becoming sick with a runny tummy. So if you have an inkling of a suspicion that your stomach is starting to get a bit upset, don't trust a fart. They are not all innocent. Particularly don't trust a fart if you think you're getting sick when you're in a public place or on a long distance bus or nowhere near a bathroom. Trust me. Sometimes it's not just air that comes out.
If you didn't listen to Rule #1 and you're in a public space, then don't forget the magical powers of tying something around your waist. No, it won't make you feel cleaner and it won't cover up any smell. But when you're walking through the business district in Buenos Aires, a sweatshirt or a long-sleeve shirt tied around your waist can give you a small feeling of decency and make an awful situation feel at least a tad better until you can get somewhere to clean yourself (and your pants) up.
If you're out on the town and you don't have anything to tie around your waist, then slip into the nearest bathroom and do damage control. If you're wearing underwear, chances are the accident didn't make it all the way to your pants. So ditch the underwear (see Rule #3), clean yourself up as best you can, and then make your way back to your room as quickly as possible. Don't worry if there's a stain. Most people aren't going to be looking at your ass anyway. (Yes, really.) And if they do, well, one of the advantages of traveling is that you can choose never to see folks again.
This isn't as obvious as you might think. Take a look at everything you're bringing on your trip. Chances are your packing list is incorrectly assuming you can't buy basic items in another country. But guess what? Deodorant, aspirin, toothpaste, and even underwear are sold in other countries too. So if something goes wrong (very unfortunately wrong) when you're sick with a runny tummy and you don't make it to the toilet in time, you do have options available. First, you can wash your underwear and pants by hand in the sink if the situation wasn't too bad. (Is this the point where I admit I've done this for Tim and he's done this for me while the other one has been sick? True love knows no bounds.) Or you can chuck your soiled clothes and go out and buy some new digs. Once you're feeling better, of course.
Before our trip, Tim and I carefully added Imodium to our packing list. And then we proceeded to get sick a few times in South America and totally forgot it was in our medical kit. When we finally remembered it, it was twenty minutes before an upcoming 22 hour bus ride (the aforementioned bus ride through the Andes mountains in Peru). My stomach had begun rumbling earlier in the morning when we took the taxi from our hostel to the bus station, and then began voicing opposition quite forcefully just before we got on the bus. Unsure what to do, Tim thankfully remembered the Imodium, quickly read the instructions, and gave me a couple of pills to swallow and stop the impending doom.
The Imodium we have allows us to take two pills after your first "watery bowel movement." And we can take a subsequent pill after each additional watery bowel movement until things settle down or until we've reached eight pills in one 24 hour period. (Usually we only need to take the first two pills and then sometimes 2-3 more.) Your pills might be different, so be sure to check.
Two things to remember about Imodium. First, there are a few instances where it's not recommended (i.e. blood in your stool) so talk with your travel doctor before you leave. And second, it doesn't cure the problem, it only alleviates your symptoms. In other words, it clogs everything up so you don't have to rush to the bathroom seven times each hour. This, as you might imagine, is a miracle on travel days. It's also nice when you're just tired of running to the bathroom and you need to get some sleep when you're sick with traveler's woe.
When you have a runny tummy food might be the furthest thing from your mind or you may still have a fairly healthy appetite. (For our part, Tim never wants to eat when he's sick while I become ravenous.) Every person is different when they get sick, and traveler's woe is no exception. If you're still pretty hungry, keep in mind that foods that usually upset your stomach (i.e. if you're a touch lactose intolerant, for example) or are a bit more challenging for stomachs to process under normal circumstances (corn, beans, spicier foods) will still do so when you're sick.
Blander foods like rice, plain potatoes, noodles, or broth will usually be a better bet. And you know what else is okay? Eating western food. I know when you're in Thailand the last thing you thought you'd eat are McDonald's french fries. But sometimes french fries are kind of nice. So go ahead and eat whatever you can or whatever is most appealing to you. When you get better, then you can swear off western food again.
(This tip also applies to all manners of comfort. Remember, there's nothing that says you can't splurge for the room with the cable TV when you're sick.)
If you have no interest in eating much at all, that's fine. But you have to keep yourself hydrated. When you have traveler's diarrhea you lose an amazing amount of liquid. And if you don't keep water, tea, ginger ale, or Gatorade coming in at a corresponding rate, then not only will you be facing traveler's woe but you'll be facing dehydration too. So stock up on some bottled water and keep it by your bed.
Tim and I never did dorm rooms when we traveled, we always opted for private rooms sometimes with a private bathroom and sometimes with a shared bathroom. But during the times we were sick, we always had rooms with private bathrooms. If we hadn't, we surely would have switched. There is nothing fun about traveler's woe. The number of times you have to rush from your bed to the bathroom (and the number of near misses you'll have along the way) is astounding. You usually won't have time to get dressed, open your door, race down a hall, and hope the shared bathroom is available. Not to mention you won't feel up to that kind of song and dance. And if you're in a dorm on top of all that? I don't see how you'll be anything but miserable.
So do yourself a favor: if you're sick, splurge on the private room with the private bathroom for a few days. You'll be much more comfortable, and the line of fellow travelers who would have been forming outside the shared bathroom door will be happier too.
Ciprofloxacin or Cipro is an antibiotic commonly prescribed to not only relieve the symptoms of traveler's woe but to knock it right out of your stomach too. It is a wonder drug. It is a miracle for travelers. It is – other than our passports and ATM cards – the most important thing we pack.
The prescription that was given to us by our travel doctor was one tablet, two times a day, for three days (a total of six pills at 500mg each). I've seen other scripts written for different amounts, though, so just talk to your doctor before your trip. Given traveler's diarrhea can surprise any traveler, I'd recommend having at least one full course of pills on you at the beginning of your trip. Although getting medicine in other countries is usually much easier and cheaper than it is in the US (we've only ever had to go into a pharmacy and ask for pills, no prescription was necessary), it would be unfortunate if the first time you had to do that (usually in another language and/or while miming) is when you had a sweatshirt tied around your waist (see Rule #2).
When Tim was sick for nearly two weeks in Buenos Aires, it was because we didn't start him on Cipro until the beginning of the second week. In hindsight we were insane to let him be sick for that long. But it was our first real experience with traveler's diarrhea, we were gun shy about using the Cipro for the first time, and he did seem to be getting better very slowly without antibiotics. But after his first two doses of Cipro, he improved dramatically. During subsequent bouts of traveler's woe, we'd usually wait 1-2 days before starting Cipro to see if our body's got better on their own. (They usually didn't for us, including my most recent bout with a runny tummy after traveling to Bogota, Colombia.) But talk with your doctor before you travel and then make the decision that feels best to you. Remember, though, to complete your full course of Cipro once you start it.
Tim and I are incredibly lucky to travel as a couple. When one of us is sick, the other one can go out to get comfort food, or more bottled water, or simply help the sicky one feel better. But I know there are several folks who read this travel blog who travel on their own. And facing illness when traveling by yourself, no matter if it's the flu or traveler's diarrhea, is no small feat. So do yourself a favor when you get sick. Don't be shy about befriending someone else in the next room over. Or better yet, let the person running your hostel or hotel know that you're sick and in need of some help. Chances are they'll know the places who who will deliver food or they might even make you food themselves. At the very least, I'm sure they wouldn't mind sending someone out to pick up some bottled water or some medicine so you don't have to. We have been consistently amazed at the kindness of strangers around the world. And I'd be surprised if the person you asked for help wasn't eager to do so or find someone else who can help you.
As I mentioned above, Tim was sick with traveler's woe for nearly two weeks because we didn't have him take the Cipro soon enough. But as soon as we started the Cipro, he improved dramatically. But if he hadn't improved after the Cipro, or if we didn't have the Cipro, or if his symptoms had gotten worse during that time we would have gone to a doctor. Likewise, if he had blood in his stool, a high fever for several days, or extended cramping (lasting for 10-15 minutes each time without relief, for example), we would have gone straight to the doctor. Those last symptoms I just mentioned go beyond the traditional traveler's woe and can be an indication that medical attention is necessary.
If you're worried about how much it will cost to see a doctor in another country, keep in mind it will most likely be cheaper than seeing a doctor in your home country. It may even be easier to get an appointment. Most guidebooks will list reputable doctors throughout the chapters. Your hotel or hostel or fellow travelers may be able to recommend someone too.
If you've read a bit about traveler's woe and your symptoms seem to match, then you may have some form of it. But there are many nasty buggies and conditions you can get anywhere in the world, some of which start out looking like traveler's diarrhea. So if you're in doubt or if things just don't feel right, go see a doctor. There are no advantages to waiting it out. This goes double if you're traveling alone and there's no one else to keep track of how you're doing.
It's true that being sick abroad can be a scary experience. And there are many times when I've had traveler's diarrhea and have been scared by how sick I was. But if you take care of yourself, give yourself time to get better, and remember there are doctors all around the world (just like aspirin and underwear!) then I bet you'll feel a bit more comfortable too.