Traveler's Diarrhea

By Tiffany Tseng. May 7th 2016

Vacations are a time for relaxation, where you recharge your batteries before going back to the “real world” to face day-to-day toils. One of the most unpleasant things that can easily ruin a vacation, however, is the notorious traveler’s diarrhea, also known as TD or “Montezuma’s Revenge.” Fortunately, traveler’s diarrhea is rarely fatal and usually goes away by itself after a few days.

Possible Causes

Traveler’s diarrhea mostly affects individuals who aren’t used to the sanitation standards of other countries. These individuals have immune systems that may not be as well-equipped to fight foreign pathogens, diarrhea can occur.

Specifically, some of the microorganisms that cause TD include:

  • Bacteria, including E. coli, C. jejuni, Shigella, Salmonella, Yersinia, non-cholera Vibrio
  • Viruses, including Rotavirus and the Noroviruses
  • Parasites, including Giardia lambli, Entamoeba histolytica, Cyclospora cayetanensis, and Cryptosporidium parvum

The most common culprit of traveler’s diarrhea is E. coli, due to fecal contaminated water. Travelers should be very cautious about using the local tap water for drinking, or even for brushing their teeth.


TD is generally defined as a traveling person having three or more cases of unformed stool or diarrhea within 24 hours. Other symptoms can also include:

  • Bowel movement becomes watery, and volume and weight of stool increases
  • Abdominal cramps
  • Nausea
  • Vomiting
  • Fever
  • Some dehydration
  • Bloating
  • Increased frequency and urgency to defecate

It is important to note the difference between food poisoning and traveler’s diarrhea, as it is caused by different strains of microorganisms. With food poisoning, the microorganisms need longer incubation time (the time needed for the organism to multiply until it causes symptoms), and symptoms are different between the two conditions. Food poisoning can also include symptoms such as numbness and reversal of temperature sensations.

While traveler’s diarrhea is rarely fatal, be sure to see a doctor if there are signs of severe infection, including:

  • Severe dehydration
  • Bloody stools
  • Persistent vomiting
  • High fever that does not go down
  • If the affected is a child, and diarrhea last longer than a few days


Traveler’s diarrhea can be easily treated with prescribed antibiotics and anti-motility agents, which slow down muscle activity in the gastrointestinal tract and alleviate pain. It is usually up to the doctor to determine which medicine will be best suited for each condition, as treatment for children and pregnant women may vary.

If you cannot get yourself to a doctor, try these tips at home to alleviate symptoms:

  • Avoid all harsh foods and drinks, such as alcohol, caffeine, dairy products, and acidic juices (such as orange juice).
  • Keep drinking fluids to up hydration. Diarrhea depletes the body of fluids, and you do not want to become dehydrate.
  • Apple juice, clear soup, and sports drinks are great rehydration options if water is too boring for you.
  • Pepto Bismol, an over the counter stomach drug, may provide some alleviation (but not always).
  • Probiotic supplements, also found over the counter, may help, although more studies are needed. Be sure to avoid dairy products, however, as they can make symptoms worse; opt for supplements in pill form instead.
  • When the stomach is a little stronger, you can move onto a diet of easy to digest complex carbohydrates, such as saltine crackers, applesauce, dry toast, and bananas.


Here are some tips to minimize your chances of getting traveler’s diarrhea next time when you are on a vacation in another country:

  • The rule of thumb of eating for travelers is, “boil it, cook it, peel it, or forget it.” It is the same for drinks that are not pre-bottled at a legitimate factory.
  • Avoid food from street vendors. Your body may not be equipped to deal with the microorganisms that the locals and natives’ gastrointestinal track is already familiar with.
  • Avoid unpasteurized milk and dairy products, especially ice cream.
  • Avoid raw or undercooked meat, fish, and shellfish.
  • Avoid food served at room temperature or a warm environment, such as buffets and sauces that have been out the entire day.
  • Have your food be well-done and served piping hot.
  • Avoid fruits and vegetables that you cannot peel, such as grapes and berries. Instead, be sure to eat those that require peeling instead (avocados, bananas, oranges, etc).
  • Contrary to belief, drinking alcoholic drinks will not “kill” the bacteria that can cause TD in food or contaminated ice.
  • For safe drinking water, be sure to bring it to a boil prior to drinking. Iodine tablets do not kill certain parasites that can also cause TD.

Unless you are familiar with the country’s food rules and regulations, it is always better to err on the safe side. Make sure you eat foods that are thoroughly cooked, and stick to bottled water. Now that you have this knowledge to protect yourself, you can look forward to your next out-of-country vacation. Bon voyage!


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