Travelling with IBD
Last Updated: 02/12/2015
You may find the thought of travelling daunting if you have Crohn’s Disease or Ulcerative Colitis, but with adequate preparation there is no reason why you cannot travel and experience everything the world has to offer.
People with IBD are exposed to two main risks during travel1
- Relapse (flare) of IBD due to gastrointestinal infections acquired during travel, change in dietary habits, forgetting to take your medication or unavailability of IBD medication.
- Acquiring infectious diseases common to developing countries, which may be more severe in IBD patients who are immunosuppressed.
Good planning and research will help to reduce these risks. The information in this section gives you practical advice on traveling with IBD.
Planning your trip
It may be useful to consider the following:
- It is better to travel when your IBD is stable. This will prevent the risk of a flare-up and also reduce your insurance premiums.
- Always ensure you have adequate travel insurance to cover your IBD.
- Obtain a letter from your specialist outlining your medical history and medication.
- Consider your travel destination. A backpacking trip around Burma will carry different risks and need more preparation than going to America. Take into consideration your current health and the facilities available in the country you are visiting.
- Do you need any vaccinations before your trip? You may need these up to 8 weeks before you travel so plan ahead and visit a travel clinic. You may also be taking medication that prevents you from having some vaccinations. See our vaccination page for more details.
- Ensure you take an adequate supply of medication with you. Our travel with medication page has more advice regarding this.
- Always pack a sunscreen to protect from UVA and UVB rays. Some medication used in IBD such as azathioprine or mercaptopurine can make your skin more sensitive to the sun and therefore sunscreen is even more important to prevent the risk of skin cancers.
- If you are on medication that needs to be kept cold, does your accommodation have an in-room fridge?
- Choose accommodation to suit you. Does it have a private or shared bathroom? If shared, is the bathroom on the same floor?
- If stress makes your symptoms worse, then plan your trip to be as stress free as possible. A busy itinerary may sound great, however you may feel so exhausted, you cannot enjoy your trip.
- Escorted or independent travel? A tour may save time and worry of making arrangements. The tour leader will know how to access medical care and where the toilets are.
- Working abroad? If you plan to do welfare work in developing countries you may be at higher risk of some infections. This should be discussed with your IBD team/ travel clinic.
- Mode of travel.
- Bus trips - Ensure there is a toilet onboard, especially for long trips.
- Request an aisle seat where possible
- Request special meals where possible with airlines/ bus company
For information on traveling after surgery and with a stoma, please see our travel after surgery page
IBD should not stop you following your dreams and ambitions. Sharing experiences of travel with IBD is a good way to encourage others. The Blogs below have been written by people with IBD who.
Healthy Globe-trotting Blog
Miss Lizzy Barlow travel Blog
The European federation of Crohn’s and Colitis organisation (EFFCA)4 association website contains useful tips on living with IBD and a list of support groups throughout Europe who you can contact for country specific information or foreign language can’t wait toilet cards. http://www.lifeandibd.org/european-support-groups.html
You can also obtain a foreign language ‘Can’t wait card’ that explains you have a medical condition meaning you need the toilet urgently from your local Crohn’s and Colitis organisation (e.g Crohn’s and Colitis UK).
See the managing travellers diarrhoea page for more useful information
You may find it useful to join MedicAlert Foundation, http://www.medicalert.org.uk/ an international network in over 100 countries. Emergency personnel and healthcare professionals are trained to recognise your MedicAlert I.D. jewellery so that they can get you the right treatment.
Emergency Travel Kit 4,6
Carrying a kit in your luggage that contains essentials that you may need during your trip will help remove anxiety about traveling away from home and enable you to be more prepared in the event of a bowel accident. It is a good idea to pack this in your hand luggage. Suggested things for the emergency travel kit include:
- A supply of sanitary pads,
- Change of underwear and clothes
- Wet wipes and toilet roll
- Antibacterial hand wash
- A small aerosol odour neutraliser
- Small kit of dressings, tape and saline for wound cleaning etc.
- Multi-lingual can't wait card (see above).
Medication- keep in your hand luggage.
- Antibiotics such a ciprofloxacin for travellers' diarrhoea
- Loperamide or lomitil for diarrhoea relief (This can sometimes hide symptoms of a flare so use with caution)
- Oral rehydration salts (e.g. Dioralye).
- Buscopan or IBS relief medication
- Paracetamol to reduce fevers (beware of products containing codeine- ensure prescriptions are labelled with your name)
- Adequate supply of your regular medication, including steroids in case of a flare.
Coping with language barriers
Write down a few useful phrases in the language of the country you are visiting. There are many free apps available that can help you with this including Google translate http://translate.google.com/
Some suggestions of phrases to translate include:
“Where is the toilet please?”
“I am ill and need a doctor”
“I have a problem and need help”
“I have a temperature”
“I have abdominal pain”
Air travel is becoming increasingly popular, with people choosing to visit international destinations, areas that are less economically developed, or to undertake more adventurous activities such as skiing, scuba diving or trekking at high altitude.
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 hides 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.
Flights, journeys to high altitude and IBD
Journeys to areas of high altitude (over 2000m/ 6,500ft above sea level) are becoming increasingly common, with many people underaking 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 factors 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
Avoiding Deep Vein Thrombosis (DVT) 2
What is DVT?
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.
There are no immediate symptoms but typical signs include:
- Swollen or painful calf or thigh,
- paleness and increased heat around the affected area (usually legs)
Risk factors for DVT 2,3
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 IBD have an increased risk of blood clots, particularly if you have had recent surgery.
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.
Other risk factors include:
- History of DVT or pulmonary embolism
- Heart disease
- Inherited tendency to clot (thrombophilia)
- Recent surgery (Abdominal region or legs)
- Hormone replacement therapy
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
- 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.
Source of information:
- 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.
- NHS Choices. Preventing DVT when you travel http://www.nhs.uk/Livewell/travelhealth/Pages/PreventingDVT.aspx (last accessed 28/8/2014)
- 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.
- Crohn's and Colitis UK. Travel and IBD information sheet. www.crohnsandcolitis.org.uk
- Mills D. Travelling well. The must have guide to a safe a healthy journey. – www.travellingwell.com.au (last accessed 28/8/2014)
- Spira A. Preparing the traveller. Travel medicine. 2003:361 1368-1381
- 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
- NHS Fit for travel. High altitude and travel http://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/altit...
- Jen Farmer ( @jenbalancebelly ) Travel Blog www.abalancebelly.co.uk