Dealing With ‘Bali Belly’

Many people who travel to developing countries experience traveller’s diarrhoea, also coined ‘Bali belly’. This illness can occur at any time during the trip, or even after you get home. It is usually a self-limiting condition that clears up after a few days. It is often caused by eating contaminated food or water. The micro-organisms that trigger the illness may appear to be harmless to the local population, presumably because local people have acquired immunity to them. The risk of traveller’s diarrhoea is higher where sanitation and hygiene standards are poor, such as in the developing nations of Latin America, Africa, the Middle East and Asia.

Symptoms to watch for

If you are traveling then here are some of the symptoms to look out for:

  1. Abdominal bloating, cramps and pain
  2. Nausea
  3. Urgency to go to the toilet
  4. Loose, watery stools (faeces or poo) passed frequently
  5. Mild temperature
  6. General malaise (weakness or discomfort).

Causes of traveller’s diarrhoea

Its important to understand which micro-organisms can cause traveller’s diarrhoea because this will help with your treatment options. The common culprits include:

  1. Bacteria – Escherichia coli (E. coli), primarily enterotoxigenic strains (ETEC). This is one of the most common bacterial causes of traveller’s diarrhoea. Other bacterial causes of traveller’s diarrhoea include Campylobacter jejuni, Salmonella species and Shigella species. These infections are usually associated with severe abdominal pains and fever
  2. Parasites – certain parasitic infections are known to cause diarrhoea, including Giardia intestinalis, Entamoeba histolytica and Cryptosporidium parvum. In these cases, the illness lasts longer than a few days and the stools may be bloody
  3. Viruses – some estimates suggest that around one in three cases of traveller’s diarrhoea is caused by or associated with a viral infection, particularly norovirus and rotavirus
  4. Unknown causes – a cause can’t be found in approximately one-fifth to half of all cases of traveller’s diarrhoea. It is thought that diarrhoea may be the gastrointestinal system’s response to unfamiliar micro-organisms.

Risk factors: Contaminated foods

Consuming contaminated food is a major cause of traveller’s diarrhoea. Some high-risk foods that you should avoid include:

  1. Raw and peeled fruits and vegetables
  2. Green leafy vegetables such as spinach and lettuce
  3. Raw, rare or undercooked meats of any kind
  4. Seafood, particularly raw or inadequately cooked shellfish or fish
  5. Sauces and mayonnaises
  6. Unpasteurised dairy foods, including milk, yoghurt, ice cream
  7. Food from street vendors
  8. Any hot food that has been left long enough to cool
  9. Food buffets.

Risk factors: Contaminated water

Water contaminated with infected faeces is another common cause of traveller’s diarrhoea. The best rules of practice include:

  1. If you are not sure of the safety of the water supply, avoid drinking the water or brushing your teeth with it.
  2. Buy bottled water to drink, preferably carbonated.
  3. Boil tap water for at least five minutes before drinking it.
  4. Avoid any drinks that contain ice.
  5. Avoid using tap water to wash your fruit and vegetables.

Hygiene practices to prevent traveller’s diarrhoea

You can further reduce your risk of traveller’s diarrhoea by practicing good hygiene. Wash your hands with soap and water after going to the toilet, and before eating or preparing food. After washing your hands, make sure they are completely dry before you touch any food.

Make sure any dishes, cups or other utensils are completely dry after they are washed. And of course, choose to eat at reputable and clean restaurants.

Treatment for traveller’s diarrhoea

While some of the new cholera vaccines can also help prevent the common E. coli diarrhoea, there is no vaccine that can reliably prevent traveller’s diarrhoea. The best defence is prevention. In most cases, traveller’s diarrhoea is self-limiting and tends to clear up in around four days.

All forms of treatment aims to ease some of the symptoms and prevent dehydration. So start by drinking plenty of clean, bottled water to avoid dehydration. Then,

  1. Drink rehydration drinks to replace lost salts and minerals
  2. Limit the amount of dairy foods you eat as this can worsen the diarrhoea
  3. Avoiding alcohol and spicy foods
  4. Avoiding anti-diarrhoea drugs if you have a high fever – preventing the passage of stools will only keep a bacterial infection and its poisons inside the body for longer.
  5. Take a suitable probiotic to help replenish gut flora.

Enduring one bout of traveller’s diarrhoea doesn’t offer any protection against developing it again. This is because so many different infectious agents are capable of causing the illness.

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