Air travel & High altitude journeys

  • Air travel is the most popular transportation mode for people choosing to visit international destinations. Several particular points will help you through air travel more easily and prevent the risks of thrombosis, which is rarely associated with flights (see below).
  • At the airport
  • Avoid awkward situations at airport/ customs security by following a few simple steps:
  • Ask your IBD team to give you a travel with medication letter to prove why you need to carry medication in your hand luggage. An example of this is available in my MyIbd section.
  • If you have a stoma, obtain a travel certificate from your stoma company or nurse. This is available in multiple languages Details of this are available on the travel after surgery section of this site.
  • Individuals who have had surgery and have a stoma may find that cabin pressure in aircraft can cause excess bloating and wind. If your stoma appliance has a filter this will enable air to escape and also hide any embarrassing odours. If you do not have an appliance with a filter you can contact your stoma company or stoma nurse to see if appliances with this are available. See our travel after surgery section for more information.

At the airport

  • Avoid awkward situations at airport/ customs security by following a few simple steps:
  • Ask your IBD team to give you a travel with medication letter to prove why you need to carry medication in your hand luggage. An example of this is available in my MyIbd section.
  • If you have a stoma, obtain a travel certificate from your stoma company or nurse. This is available in multiple languages Details of this are available on the travel after surgery section of this site.
  • Individuals who have had surgery and have a stoma may find that cabin pressure in aircraft can cause excess bloating and wind. If your stoma appliance has a filter this will enable air to escape and also hide any embarrassing odours. If you do not have an appliance with a filter you can contact your stoma company or stoma nurse to see if appliances with this are available. See our travel after surgery section for more information.
  • Journeys to areas of high altitude (over 2000m/ 6,500ft above sea level) are becoming increasingly common, with many people undertaking adventure holidays that include trekking the Inca trail in Peru, climbing Kilimanjaro in Tanzania or Everest base camp in Nepal. High altitude activities can cause altitude sickness due to changes in the air pressure and oxygen concentration. Aircraft cabins are pressurised to an altitude of 2000-2,500m (8,0000ft) above sea level. A recent study7 suggests that hypoxia (reduced oxygen supply to the body) may cause inflammation and therefore journeys to high altitude may possibly be a risk factor for a flare of IBD.
  • It is important to note that this is only early research and the exact link between high altitude and an IBD flare needs to be researched further.
  • For details of how to prepare for a journey to high altitude please see the NHS Fit for Travel website

Deep Vein Thrombosis (DVT) , travel and IBD

DVT or blood clots can be a risk for people sitting still on a long journey. Long haul flights lasting over 8 hours are thought to be more likely to cause blood clots, but long journeys by car, bus or train can also put you at danger.

People with inflammatory bowel disease have three times more risk of developing DVT than the general population3 . The risk is higher if you have a severe flare of your disease that requires hospitalisation, if your disease is active or if you had a recent surgery. 2,3

Risk factors for DVT include:

  • Previous history of DVT or pulmonary embolism
  • Cancer
  • Stroke
  • Heart disease
  • Inherited tendency to clot (thrombophilia)
  • Recent surgery (Abdominal region or legs)
  • Obesity
  • Pregnancy
  • Taking hormone replacement therapy or birth control pills
  • Smoking

How to reduce the risk of DVT 2

  • See your GP or IBD team before travel if you have any of the above risk factors
  • Wear loose fitting, comfortable clothing
  • Store luggage overhead so you have room to stretch out your legs
  • Drink plenty of water
  • Avoid alcoholic drinks before and during the journey
  • Avoid smoking
  • Rotate your ankles regularly and exercise your calf muscles by periodically pressing hard on the seat base in front of you (same as you would press the gas pedal in your car)
  • Walk at regular intervals around the plane cabin or train carriage or during stops on bus and car travel
  • Wearing travel compression socks/stockings – it is vital that they are properly fitted. These are available from most pharmacies.
  • Deep venous thrombosis (DVT) during and after air travel
  • Deep vein thrombosis (DVT) occurs when blood flows too slowly through the veins. The blood forms a clot that blocks up deep veins, usually in the legs.
  • Typical signs and symptoms include:
  • Swollen or painful calf or thigh,
  • paleness and increased heat around the affected area (usually legs)
  • DVT in the legs are at risk of dislodging and traveling through veins to the lungs where they form pulmonary embolism. Pulmonary embolism from DVT is potentially a life threatening situation, manifesting as acute shortness of breath and/or acute chest pain and/or rapid heart rate.
  • If you experience any of these signs or symptoms, either during flight or soon thereafter, you should seek medical help immediately.

Source of information:

  1. Rahier JF, et al, Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease, J Crohns Colitis 2014; 8: 443-468.
  2. NHS Choices. Preventing DVT when you travel http://www.nhs.uk/Livewell/travelhealth/Pages/PreventingDVT.aspx (last accessed 28/8/2014)
  3. Nguyen et al. Consensus statements on the risk, prevention and treatment of venous thromboembolism in inflammatory bowel disease: Canadian association of Gastroenterology. Gastroenterology 2014; 146; 835-848.
  4. Crohn's and Colitis UK. Travel and IBD information sheet. www.crohnsandcolitis.org.uk
  5. Mills D. Travelling well. The must have guide to a safe a healthy journey. – www.travellingwell.com.au (last accessed 28/8/2014)
  6. Spira A. Preparing the traveller. Travel medicine. 2003:361 1368-1381
  7. Vavrika S R, Rogler G, Maetzler S et al. High altutude journeys are associated with an increased risk of flares in inflammatory bowel disease patients. Journal of crohns and colitis. 2014;8:191-199
  8. NHS Fit for travel. High altitude and travel http://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/altit...
  9. Jen Farmer ( @jenbalancebelly ) Travel Blog www.abalancebelly.co.uk
  10. Rahier JF, et al, Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease, J Crohns Colitis 2014; 8: 443-468.
  11. NHS Choices. Preventing DVT when you travel http://www.nhs.uk/Livewell/travelhealth/Pages/PreventingDVT.aspx (last accessed 28/8/2014)
  12. Nguyen et al. Consensus statements on the risk, prevention and treatment of venous thromboembolism in inflammatory bowel disease: Canadian association of Gastroenterology. Gastroenterology 2014; 146; 835-848.
  13. Crohn's and Colitis UK. Travel and IBD information sheet. www.crohnsandcolitis.org.uk
  14. Mills D. Travelling well. The must have guide to a safe a healthy journey. – www.travellingwell.com.au (last accessed 28/8/2014)
  15. Spira A. Preparing the traveller. Travel medicine. 2003:361 1368-1381
  16. Vavrika S R, Rogler G, Maetzler S et al. High altutude journeys are associated with an increased risk of flares in inflammatory bowel disease patients. Journal of crohns and colitis. 2014;8:191-199
  17. NHS Fit for travel. High altitude and travel http://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/altit...
  18. Jen Farmer ( @jenbalancebelly ) Travel Blog www.abalancebelly.co.uk