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Travellers’ diarrhoea

Last Updated: 18/04/2016

Having IBD may not necessarily make you more susceptible to traveller's diarrhoea than other people. Paying close attention to precautions regarding food and water during travel will help avoid this issue.

Diarrhoea may be accompanied by nausea, vomiting and/ or fever. Most diarrhoeal attacks should clear up in a few days.

It is a good idea to ask your IBD team for a written plan of action in case you have a flare of your IBD whilst traveling.

How to avoid travellers’ diarrhoea2

  • If you are in a developing country or area with questionable sanitation don't drink the water--unless you boil it first.
  • Drink bottled mineral water, even when brushing your teeth.
  • Try not to swallow the water when showering/ swimming.
  • Avoid non-carbonated beverages, such as iced tea and fresh juices.
  • Avoid all ice and ice cream; raw vegetables and salads; raw or uncooked meat, fish, or shellfish.
  • Avoid uncooked dairy products unless you are certain that they have been pasteurized and prepared under sterile conditions.
  • Avoid food from vendors' carts.
  • Avoid food that has been kept at room temperature
  • Peel all raw fruits
  • Dishes containing raw or undercooked eggs, such as home-made mayonnaise, some sauces and some desserts (e.g. mousse) may be dangerous

What to do if you get diarrhoea?3,4

  • Drink plenty of fluids, preferably lukewarm or weak tea. Boil all water first!
  • Avoid ice-cold beverages, sodas, or citrus drinks, which could aggravate diarrhoea.
  • Take extra salt in your diet or re-hydration medication such as Dioralyte to prevent dehydration.
  • Anti-diarrheal medications, such as Imodium® (loperamide) or Pepto Bismol®, may be effective.
  • Consult a doctor if possible to provide them with a stool specimen to test for bacterial pathogens & parasites
  • If you do not have any medication in your emergency kit then consult a doctor to get a prescription for a 3-day course of ciprofloxacin 500 mg twice a day (adults) or azithromycin.

Top Tip! If your IBD has been stable for a number of years then taking medication such as ciprofloxacin 500 mg twice a day in your emergency kit should be adequate; however, if your IBD has been active and you have been unwell in the 6 months prior to your trip, your IBD team may recommend that you take ciprofloxacin 500 mg twice a day for the entire trip. It is important to discuss this with your IBD team.

If you are taking immunosuppressant medication (See our Vaccinations page for details of what these are) then you should not leave your symptoms too long before initiating self-therapy for traveller's diarrhoea with ciprofloxacin or azithromycin1

If your symptoms do not settle:

  • Follow your management plan from your IBD team.
  • Call for medical advice either from a local doctor or by calling/e-mailing your IBD team. Early treatment may prevent your problem developing into an emergency

If you experience any of the symptoms below you should seek medical advice:

  • High fever (above 37.5 C / 100 F) and shaking chills could represent a bacterial inflammation that requires intravenous antibiotics.
  • Profuse bloody diarrhoea suggests marked ulceration of the intestines, caused by a bacterium, parasite, or a flare-up of IBD.
  • Persistent severe abdominal pain and/or abdominal bloating could indicate a complication of your IBD, especially if accompanied by severe abdominal tenderness or nausea and vomiting.
  • Passing small amounts of dark yellow, concentrated urine could indicate dehydration.

Returning travellers' with diarrhoea should have a stool test for bacterial pathogens, ova and parasites and a complete blood count to identify eosinophilia. For long-term travellers with IBD returning from countries with a high-risk for the intestinal parasite strongyloidiasis, serological blood test for strongyloidiasis should be considered.1 The Centres for Disease Control and Prevention provide more details of this on their website http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal...

Dehydration

Returning travellers Dehydration is a lack of water in the body.  Hot climates and physical activity can make you more prone to dehydration.

If you have had surgery to remove part of your bowel, such as your colon or ileum, you may be more susceptible to dehydration because your body will not be able to absorb fluid and electrolytes (essential salts) from your diet as effectively6

Signs of dehydration include thirst, dark urine, passing urine infrequently, headaches, and lethargy.

Treatment of dehydration: A packet of salty crisps  or drinking flat cola is an easy way to get extra salt but in moderate to severe cases you may need oral rehydration solutions or to seek medical advice.

General information regarding managing diarrhoea and dehydration can be found on the Crohn's and Colitis UK website

Managing diarrhoea

http://www.crohnsandcolitis.org.uk/Resources/CrohnsAndColitisUK/Documents/Publications/Info-Sheets/Managing-Diarrhoea.pdf

Dehydration

http://www.crohnsandcolitis.org.uk/Resources/CrohnsAndColitisUK/Documents/Publications/Info-Sheets/Dehydration.pdf

Finding toilet facilities overseas

Finding a bathroom can cause anxiety at the best of times but this can be made worse when you are in a strange country or city. It is a good idea to have a basic understanding of the toilet customs in your destination, for example some countries will have squat toilets, others will use a faucet rather than  toilet paper. Most of this information can be found in destination guidebooks.

As someone with IBD, you will no doubt already be experienced in sourcing toilet facilities. Don’t be afraid to use everything at your disposal such as restaurants, pubs/ bars, shops, public toilets or hotels. Ensure you take a multi-language can’t wait card from your country’s IBD support group to make communicating easier.

The UK has a radar key scheme where people with IBD can apply for a  key that gains access to numerous disabled access toilets in the UK

Some toilet facilities, particularly those in public places such as train stations in London, UK, may require payment to use. It is a good idea to carry small change in local currenty in case this occurs. Many other places may let you use toilet facilities if you show a 'Bathroom emergeny card' available from most local IBD patient charities. 

There have been several websites and app’s developed to help you locate toilet facilities both in the U.K and abroad.  A few of these are listed below.  Please feel free to contact us if you have any useful information or know any other apps or website that we could list.

Apps for android or iphone use the phone's GPS to locate and produce a map of the toilets closest to you. Many app’s also contains ratings for each toilet and allow you to rate and add toilets  To locate each app type the name into your phones app store.  The links below are for iphone only.

 

 Toilet finder websites and  Smartphone 'apps'

The apps can be found by visiting iTunes and typing the app names below in the search facility or by following the link provided.

 

Worldwide directories

Get Flushd  

(app store) https://itunes.apple.com/ca/app/flushd/id691150346?mt=8

Website: http://getflushd.com/

The toilet finder  

(app store ) https://itunes.apple.com/us/app/restroom-bathroom-toilet-finder/id311896604?mt=8

 The WC finder

(app store) https://itunes.apple.com/us/app/wc-app/id357225985?mt=8

 Sir or squat

App store : https://itunes.apple.com/us/app/sitorsquat-restroom-finder/id511855507?mt=8

Website: https://www.sitorsquat.com/

iPeeAddress

(app store -type IPee and scroll across)https://itunes.apple.com/us/app/ipee-address-restroom-finder/id508984460?mt=8

Where to wee

App store https://itunes.apple.com/us/app/where-to-wee/id328752324?mt=8

Website: http://www.wheretowee.com/home

Public toilets

App store: https://itunes.apple.com/gb/app/id379780247?mt=8

 

Country Specific directories

United Kingdom 

London Loos (app store) - Search 'london loos' within itunes app store

Find Toilets (app store- developed by patient.co.uk) https://itunes.apple.com/us/app/find-toilets/id646316209?mt=8

Denmark (Odense)

Public toilet Odense (App store): https://itunes.apple.com/gb/app/id510749525?mt=8

 

Belgium 

Last Updated: 18/04/2016

WC ASAPP (App store) https://itunes.apple.com/us/app/wc-asapp/id1047191207?ls=1&mt=8

Netherlands

(Website) www.medischtoiletpasnederland.nl

Switzerland

Public toilets (app store)https://itunes.apple.com/us/app/100000+-public-toilets-pro/id385462251?mt=8

France

Miss pipi tolouse (app store)https://itunes.apple.com/gb/app/id874922702?mt=8

USA and Canada

Crohn’s and colitis foundation of Canada  Toilet finder  (App store)https://itunes.apple.com/us/app/restroom-bathroom-toilet-finder/id311896604

Crohn's and Colitis Canada Go-Here toilet finder (App store) https://itunes.apple.com/us/app/gohere-washroom-locator/id1011069090?mt=8

Website: http://www.kintera.org/site/c.4nJIJXPrEbKSE/b.9268541/k.851B/About_GoHere.htm

 

Philippines

Immodium toilet tracker (App store)https://itunes.apple.com/gb/app/id526717853?mt=8

Australia and New Zealand

Australia The National public toilet map https://itunes.apple.com/app/national-public-toilet-map/id323279108?mt=8

Website https://toiletmap.gov.au/

 

Australia Elbatrop toilet finder (App store)https://itunes.apple.com/app/find-toilets-lite/id466831395?mt=8

Website: http://www.elbatrop.com/toilets

 

Show the loo (Australia) App store: https://itunes.apple.com/gb/app/id299496509?mt=8

 

New Zealand public toilet finder  (app store)https://itunes.apple.com/cn/app/nz-public-toilet-finder./id699796296?mt=8

 

 Sources 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), http://dx.doi.org/10.1016/j.crohns.2013.12.013
  2. World Health Organisation. A Guide on Safe Food for Travellers. How to avoid illnesses caused by unsafe food and drink and what to do if you get diarrhoea
  3. Crohn’s and Colitis Foundation of America. Travelling with IBD. http://www.ccfa.org/resources/traveling-with-ibd.html
  4. Spira A. Preparing the traveller. Travel medicine. 2003; 361; 1368-1381
  5. Crohn's and Colitis UK. Managing diarrhoea information sheet. www.crohnsandcolitis.org.uk
  6. Crohns and colitis UK. Dehydration information sheet www.crohnsandcolitis.org.uk
  7. Apple iTunes App store search
  8. The app shopper website. http://appshopper.com/search/?search=toilet

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