What to do for traveler’s diarrhea and constipation

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It’s that time of year when patients at my gastroenterology clinic tell me about their exciting summer plans and the dreaded scenarios that come with them. After a long break from travel, they can imagine finally dipping their toes in the cool sand by the ocean or hiking up a perfect trail to a beautiful view. But they may also imagine their stomachs suddenly rumbling during these activities, giving them an urgent signal that it’s time to leave, and with no toilet in sight.

Even the most ordinary person can lose their bowel habits while traveling. And when nature calls at an inopportune time (or perhaps fails to call at everything), it can leave holiday revelers feeling down… well, dumps.

“All of us will experience some level of impaired bowel function when we travel,” said gut motility expert Satish Rao, professor of medicine at Augusta University Medical College of Georgia. “It’s extremely common, although no one likes to talk about it.” He stressed that travelers should take proactive steps to stay regular, rather than waiting for something uncomfortable to happen.

Here’s why these nasty changes are happening in our guts and how you can prevent them from ruining your next vacation.

At the height of the pandemic, concerns about classic traveler’s diarrhea took a back seat as few people were traveling anywhere. Now that we are traveling again, you should know that 11.5% of patients with covid-19 suffer from diarrhea, according to a 2020 systematic review of 43 studies, and another 2020 systematic review found that up to 1 in 6 of these patients to have only Gastrointestinal symptoms. It is therefore always useful to have rapid antigen tests at hand on vacation.

But traveler’s diarrhea should also be on our radar, advised Ronald Blanton, chair of the department of tropical medicine at Tulane University’s School of Public Health and Tropical Medicine. Up to half of travelers Resource-rich areas of the world develop diarrhea, which is usually caused by bacteria like E. coli, according to a 2017 study published by Helsinki researchers.

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Few doctors today would recommend taking antibiotics to prevent diarrhea while traveling due to drug side effects, the fact that most cases clear up on their own (usually within five days), and resistance. widespread antibiotic use caused by overuse. Regina LaRocque, an infectious disease specialist at Massachusetts General Hospital, studied bacteria in the stools of 608 American travelers who returned from trips abroad and found that people who had taken antibiotics for traveller’s diarrhea were more likely to have drug-resistant bacterial strains in their intestines that remained there even months after their travels.

Instead of antibiotics, Blanton advises people who want to be proactive to try taking daily Pepto-Bismol, which contains bismuth subsalicylate and can be effective up to 65% in the prevention of travellers’ diarrhea.

In general, well-cooked foods are less likely to transmit pathogens. (If you eat raw food, choosing items with skins that you remove yourself, such as bananas and oranges, is safer.) Blanton also encourages travelers to adjust dinner times according to local customs. “If you go to dinner at 6 p.m. in Mexico City, that food has probably been there since noon, because people are eating [dinner] much later than that,” he explained. “So the food is prepared fresh much later.”

As for drinks, although hot steaming coffee and tea are generally fine, you should only use bottled water that you open yourself, even for brushing your teeth, depending on your location. . “It’s important to feel or see the seal on the bottle being broken in your presence,” Blanton said. If not, the bottle may have been filled from the tap or other sources.

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But even if you follow all the rules, you can still get sick. If you find yourself with traveller’s diarrhea, staying aggressive with hydration is key. It is generally safe to take a medicine such as Imodium to slow down the frequency of bowel movements – especially if you are in a stressful situation, such as about to board a flight – but anti-diarrheals should be avoided if your stools are bloody or you have a high fever. In this case, you should immediately seek local help. Other symptoms of concern include dehydration, dizziness, or the inability to keep food down.

Another reason to see a doctor is if your symptoms persist for more than two weeks, whether at home or abroad. This could be a sign of an atypical infection (such as a parasite), depending on your travel activities. Or, as I often see in my clinic, it could be the result of irritable bowel syndrome – a long-term disruption of bowel habits sometimes triggered by infection – which happens to almost a third of patients after suffering from infectious diarrhoea.

Traveler’s Constipation

Although less publicized, developing constipation while traveling is about as common as developing diarrhea (a 2003 study estimated it affected about 40 percent international travellers) and no less frustrating. Unlike an infectious etiology, traveler’s constipation tends to result from disruptions in your normal bowel routine.

“Constipation is well known among night shift workers, airline hosts and stewardesses, or nurses whose schedules are constantly changing,” said Rao, who studies how daily activities affect how the bowel moves. . In the 1990s and 2000s, he conducted experiments on healthy volunteers to examine how the colon answered eat, sleep, exercise and both physical and psychological stress.

He and his team discovered that at night the colon “sleeps” in a quieter state, but as soon as we wake up it starts buzzing with a three times higher rate of activity that lasts for about an hour and a half. . This is why many people find it easier to have a bowel movement first thing in the morning.

“Your colon has an intrinsic rhythm and clock,” Rao said. “When you travel, you can’t expect your colon to function normally, because that clock is completely broken.”

In addition, it is often difficult to exercise on vacation.

“Even if you’re relatively active, if you sit on an airplane for hours, you become almost completely still,” he said. “It doesn’t help your colon.”

Stress — a common feature of many family vacations — can also have a big effect on the way we poop. Although psychological stress can stimulate bowel movements (if you’ve ever had to use the bathroom right before your turn at karaoke, you know), most people need a “safe”, clean and preferably private chest of drawers to go to. feel comfortable pooping, Rao said. . It can be hard to find when traveling, which can lead to constipation.

Some factors, however, are more within the control of travelers. If your vacation involves indulging in low-fiber foods, which can make constipation worse, try eating more fruits and vegetables or taking a daily fiber supplement to keep things going. To combat dehydration, which can cause dry stools, I recommend that my patients drink plenty of fluids while on vacation. Finally, because drink caffeinated coffee also increases contractions in the colon, incorporating it into your morning ritual could give you the boost you need.

“I advise all my patients: Try to stick to your routine as much as possible,” Rao said. “Take some extra medicine with you if you’re already suffering from constipation to try and cope with this.”

The bottom line (no pun intended)

Traveling now, as it always has been, is all about weighing the risks and the benefits. Indulging in local cuisine and escaping your usual habits are great vacation moments. Knowing that your bowel habits will likely change during your trip, taking proactive steps to stay regular and having a plan in place if things get bad can keep the focus on relaxation and hopefully minimize the time you spend in The bathroom.

Pasricha is a Boston-based writer. Find her on Twitter: @TrishaPasricha.

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