A couple of months ago, my husband and I went to Cuba to celebrate our one-year wedding anniversary. We planned the trip to a T: every meal, all of our excursions, where we’d grab morning coffees and midafternoon mojitos. We even bought fancy bottles to filter the local tap water—the travel guidelines we’d read indicated that bottled H2O was hard to come by and that we were at an increased risk of getting sick.
Despite our best efforts, though, within two days of returning to the US, my husband and I were shaking in bed with high fevers. Our stomachs were in knots and we were making non-stop bathroom, uh, runs. We had traveler’s diarrhea (TD for short), a gastrointestinal infection that causes loose stools and abdominal cramps, among other unpleasant, flu-like symptoms.
You get TD by ingesting some sort of pathogen (a bug like norovirus, bacteria such as E. coli, or even parasites like Giardia), typically via contaminated food or water, according to the Centers for Disease Control and Prevention (CDC). Some countries don’t have the same level of public sanitation as we do in the States and you may also be exposed to germs abroad that aren’t as common here, Theresa Fiorito, MD, a pediatric infectious disease specialist and director of the family travel medicine center at NYU Langone Hospital—Long Island, tells SELF. When you’re exposed to these bugs—some of which your body rarely, if ever, encounters—they can trigger an infection and cause not only diarrhea, but also cramps, fever, and vomiting (as well as the why-the-hell-is-this-happening-to-me blues, in my experience).
Most cases are mild and resolve naturally within a few days, but some (like mine, lucky me!) can get quite serious and prevent you from going about your daily life. Either way, traveler’s diarrhea isn’t fun, and since I learned a thing or three from my battle with it, I’m here, along with Dr. Fiorito, to offer some guidance, should you travel internationally and get, to put it bluntly, the shits.
An important note: Before you consider any of the below steps, it’s best to check in with a primary care provider (PCP) or an urgent-care physician. Everyone’s different, and with TD you definitely want to do whatever your doctor says is going to help your body recover as quickly as possible. Okay, onto those recs.
Think twice about taking OTC diarrhea meds.
You may have treated past bouts of diarrhea with Imodium (or loperamide)—an over-the-counter antidiarrheal pill that can slow down an overactive gut—but it’s not always recommended for TD. Why? In certain cases, you actually want your body to expel the germs by, well, pooping, according to the Mayo Clinic. Though Imodium may ease the diarrhea, it can also keep harmful organisms in your body for longer.
According to Dr. Fiorito, it really depends on how intense your TD is and what’s causing it, which can be identified via a stool sample; your doctor can order one for you. My husband and I went to our respective PCPs, did cute little stool tests (don’t wanna get into it), and tested positive for a bacteria called Campylobacter. So we were advised to let our bowels work their magic, sans Imodium.
On to the intensity of your poops: Per the CDC’s travel guidebook, mild cases of traveler’s diarrhea don’t interrupt your daily activities (meaning, it sucks but you can handle it), moderate ones mess with your plans and can be fairly distressing, and in severe cases you’re totally unable to go about your life because the pain, the poop, the entire predicament is that intense.
However, if your TD’s on the milder side, Imodium can be helpful. According to Dr. Fiorito, a less-intense case suggests you may be infected with a virus, perhaps one that causes food poisoning; with such illnesses, antidiarrheals can slow down the runs while allowing your body to fight the infection. But if bacteria is to blame, as it was in my case, or if you have moderate to severe diarrhea (i.e. you can’t stray too far from the bathroom or there’s blood in your stool), you probably want to skip the Imodium and other antimotility drugs—and definitely go to the doctor. Bacterial infections tend to be more invasive and severe and using these meds would “just be keeping the bacteria in,” Dr. Fiorito says.
Stay hydrated by taking small sips of water.
My doctor advised me to keep drinking water since I was losing a ton of fluids, but it just seemed to make things worse. Whenever I chugged, my stomach would cramp up and I’d have to bolt to the toilet moments later.
It turns out I was going about it all wrong: Gulping down water was my mistake. Drinking too much too quickly can make your GI issues even worse. “Take small sips so as to not overwhelm the body,” Dr. Fioriti advises. This helps your kidneys process and filter the water more effectively, too, she says, so you can avoid dehydration—which can become pretty dangerous and lead to serious issues, like organ damage or shock, that require a visit to the ER. “Small sips ensure your body can use all that water without the kidneys getting overwhelmed and can process it without excreting what it doesn’t need,” Dr. Fioriti says.
While we’re on the topic: Rehydration solutions with electrolytes—which you can find in Liquid IV packets and Pedialyte—are solid choices. You can also make your own hydration cocktail. Here are a few options from Dr. Fioriti: Half a can of Coke or half a glass of Gatorade with equal parts water and a pinch of salt, or, the simplest bet: Six teaspoons of sugar, half a teaspoon of salt, plus four cups of water.
Use acetaminophen instead of NSAIDs.
When you have traveler’s diarrhea, it can feel like your intestines are at war—which is why, in moderate to serious cases, it’s smart to opt for a pain reliever like acetaminophen (Tylenol) instead of ibuprofen (Advil) or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve) or aspirin.
NSAIDs, especially with heavier use, are known to cause gut side effects in some people, including gas, abdominal pain, and gastrointestinal bleeding. With TD, your stomach’s already going through the wringer and popping too much ibuprofen could potentially add fuel to the fire. Definitely ask your doctor about this one: Though one pill likely won’t do any harm, relying on these drugs to feel better could end up making your stomach more upset, depending on your underlying health, the severity of your symptoms, and your history with NSAID use. “It’s just very irritating to the stomach,” Dr. Fioriti says.
Other than that, you want to relax as much as possible and eat small amounts of bland foods (toast! bananas!) and salty snacks (like pretzels or crackers). And as always, if you feel really, really unwell, talk to your doctor. More serious cases of TD—those that involve bloody diarrhea or more than three watery poops a day—may require a course of antibiotics to get your bowels back on track. That, sadly, was the case for me and my husband.
TD knocked me off my feet, but the moment I started following the above tips—and, eventually, letting the antibiotics do their thing—the better I felt. Rotating in and out of the bathroom wasn’t exactly how we envisioned our first-anniversary trip ending, but, hey, as they say, in sickness and in health!
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