international travel upset stomach

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• Traveler's diarrhea

Gastrointestinal tract

Your digestive tract stretches from your mouth to your anus. It includes the organs necessary to digest food, absorb nutrients and process waste.

Traveler's diarrhea is a digestive tract disorder that commonly causes loose stools and stomach cramps. It's caused by eating contaminated food or drinking contaminated water. Fortunately, traveler's diarrhea usually isn't serious in most people — it's just unpleasant.

When you visit a place where the climate or sanitary practices are different from yours at home, you have an increased risk of developing traveler's diarrhea.

To reduce your risk of traveler's diarrhea, be careful about what you eat and drink while traveling. If you do develop traveler's diarrhea, chances are it will go away without treatment. However, it's a good idea to have doctor-approved medicines with you when you travel to high-risk areas. This way, you'll be prepared in case diarrhea gets severe or won't go away.

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Traveler's diarrhea may begin suddenly during your trip or shortly after you return home. Most people improve within 1 to 2 days without treatment and recover completely within a week. However, you can have multiple episodes of traveler's diarrhea during one trip.

The most common symptoms of traveler's diarrhea are:

• Suddenly passing three or more looser watery stools a day.
• An urgent need to pass stool.
• Stomach cramps.

Sometimes, people experience moderate to severe dehydration, ongoing vomiting, a high fever, bloody stools, or severe pain in the belly or rectum. If you or your child experiences any of these symptoms or if the diarrhea lasts longer than a few days, it's time to see a health care professional.

When to see a doctor

Traveler's diarrhea usually goes away on its own within several days. Symptoms may last longer and be more severe if it's caused by certain bacteria or parasites. In such cases, you may need prescription medicines to help you get better.

If you're an adult, see your doctor if:

• Your diarrhea lasts beyond two days.
• You become dehydrated.
• You have severe stomach or rectal pain.
• You have bloody or black stools.
• You have a fever above 102 F (39 C).

While traveling internationally, a local embassy or consulate may be able to help you find a well-regarded medical professional who speaks your language.

Be especially cautious with children because traveler's diarrhea can cause severe dehydration in a short time. Call a doctor if your child is sick and has any of the following symptoms:

• Ongoing vomiting.
• A fever of 102 F (39 C) or more.
• Bloody stools or severe diarrhea.
• Dry mouth or crying without tears.
• Signs of being unusually sleepy, drowsy or unresponsive.
• Decreased volume of urine, including fewer wet diapers in infants.

It's possible that traveler's diarrhea may stem from the stress of traveling or a change in diet. But usually infectious agents — such as bacteria, viruses or parasites — are to blame. You typically develop traveler's diarrhea after ingesting food or water contaminated with organisms from feces.

So why aren't natives of high-risk countries affected in the same way? Often their bodies have become used to the bacteria and have developed immunity to them.

Risk factors

Each year millions of international travelers experience traveler's diarrhea. High-risk destinations for traveler's diarrhea include areas of:

• Central America.
• South America.
• South Asia and Southeast Asia.

Traveling to Eastern Europe, South Africa, Central and East Asia, the Middle East, and a few Caribbean islands also poses some risk. However, your risk of traveler's diarrhea is generally low in Northern and Western Europe, Japan, Canada, Singapore, Australia, New Zealand, and the United States.

Your chances of getting traveler's diarrhea are mostly determined by your destination. But certain groups of people have a greater risk of developing the condition. These include:

• Young adults. The condition is slightly more common in young adult tourists. Though the reasons why aren't clear, it's possible that young adults lack acquired immunity. They may also be more adventurous than older people in their travels and dietary choices, or they may be less careful about avoiding contaminated foods.
• People with weakened immune systems. A weakened immune system due to an underlying illness or immune-suppressing medicines such as corticosteroids increases risk of infections.
• People with diabetes, inflammatory bowel disease, or severe kidney, liver or heart disease. These conditions can leave you more prone to infection or increase your risk of a more-severe infection.
• People who take acid blockers or antacids. Acid in the stomach tends to destroy organisms, so a reduction in stomach acid may leave more opportunity for bacterial survival.
• People who travel during certain seasons. The risk of traveler's diarrhea varies by season in certain parts of the world. For example, risk is highest in South Asia during the hot months just before the monsoons.

Complications

Because you lose vital fluids, salts and minerals during a bout with traveler's diarrhea, you may become dehydrated, especially during the summer months. Dehydration is especially dangerous for children, older adults and people with weakened immune systems.

Dehydration caused by diarrhea can cause serious complications, including organ damage, shock or coma. Symptoms of dehydration include a very dry mouth, intense thirst, little or no urination, dizziness, or extreme weakness.

Watch what you eat

The general rule of thumb when traveling to another country is this: Boil it, cook it, peel it or forget it. But it's still possible to get sick even if you follow these rules.

Other tips that may help decrease your risk of getting sick include:

• Don't consume food from street vendors.
• Don't consume unpasteurized milk and dairy products, including ice cream.
• Don't eat raw or undercooked meat, fish and shellfish.
• Don't eat moist food at room temperature, such as sauces and buffet offerings.
• Eat foods that are well cooked and served hot.
• Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and from fruits you can't peel, such as grapes and berries.
• Be aware that alcohol in a drink won't keep you safe from contaminated water or ice.

Don't drink the water

When visiting high-risk areas, keep the following tips in mind:

• Don't drink unsterilized water — from tap, well or stream. If you need to consume local water, boil it for three minutes. Let the water cool naturally and store it in a clean covered container.
• Don't use locally made ice cubes or drink mixed fruit juices made with tap water.
• Beware of sliced fruit that may have been washed in contaminated water.
• Use bottled or boiled water to mix baby formula.
• Order hot beverages, such as coffee or tea, and make sure they're steaming hot.
• Feel free to drink canned or bottled drinks in their original containers — including water, carbonated beverages, beer or wine — as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring.
• Use bottled water to brush your teeth.
• Don't swim in water that may be contaminated.
• Keep your mouth closed while showering.

If it's not possible to buy bottled water or boil your water, bring some means to purify water. Consider a water-filter pump with a microstrainer filter that can filter out small microorganisms.

You also can chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but is best reserved for short trips, as too much iodine can be harmful to your system. You can purchase water-disinfecting tablets containing chlorine, iodine tablets or crystals, or other disinfecting agents at camping stores and pharmacies. Be sure to follow the directions on the package.

Follow additional tips

Here are other ways to reduce your risk of traveler's diarrhea:

• Make sure dishes and utensils are clean and dry before using them.
• Wash your hands often and always before eating. If washing isn't possible, use an alcohol-based hand sanitizer with at least 60% alcohol to clean your hands before eating.
• Seek out food items that require little handling in preparation.
• Keep children from putting things — including their dirty hands — in their mouths. If possible, keep infants from crawling on dirty floors.
• Tie a colored ribbon around the bathroom faucet to remind you not to drink — or brush your teeth with — tap water.

Other preventive measures

Public health experts generally don't recommend taking antibiotics to prevent traveler's diarrhea, because doing so can contribute to the development of antibiotic-resistant bacteria.

Antibiotics provide no protection against viruses and parasites, but they can give travelers a false sense of security about the risks of consuming local foods and beverages. They also can cause unpleasant side effects, such as skin rashes, skin reactions to the sun and vaginal yeast infections.

As a preventive measure, some doctors suggest taking bismuth subsalicylate, which has been shown to decrease the likelihood of diarrhea. However, don't take this medicine for longer than three weeks, and don't take it at all if you're pregnant or allergic to aspirin. Talk to your doctor before taking bismuth subsalicylate if you're taking certain medicines, such as anticoagulants.

Common harmless side effects of bismuth subsalicylate include a black-colored tongue and dark stools. In some cases, it can cause constipation, nausea and, rarely, ringing in your ears, called tinnitus.

• Feldman M, et al., eds. Infectious enteritis and proctocolitis. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 25, 2021.
• LaRocque R, et al. Travelers' diarrhea: Microbiology, epidemiology, and prevention. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Ferri FF. Traveler diarrhea. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed April 28, 2023.
• Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed April 27, 2023.
• Travelers' diarrhea. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea. Accessed April 28, 2023.
• LaRocque R, et al. Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
• Khanna S (expert opinion). Mayo Clinic. May 29, 2021.
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Best Traveler's Diarrhea Treatments for Symptom Relief

Sources of Bacteria, Prevention, and Medication Types

Complications

Frequently asked questions.

Traveler's diarrhea can turn a trip into a nightmare. Food and water contaminated by germs, also known as pathogens , is not uncommon in certain areas of the world that are popular travel destinations. Consuming even small amounts of these germs can cause loose, watery stool, the main sign of diarrhea , Luckily, treatment options are available.

This article explains the symptoms of traveler's diarrhea, how to treat it, and the best ways to prevent getting infected in the first place.

Luis Alvarez / Getty Images

Symptoms of traveler's diarrhea caused by bacteria or a virus usually appear six to 72 hours after eating or drinking something contaminated. With some types of pathogens, it may take a week or longer for stool to be affected.

Changes in your bowel habits it the main symptoms of diarrhea. At its mildest, diarrhea involves passing loose, watery stool three times a day. You may pass unformed stool 10 or more times a day in severe cases.

Other symptoms vary depending on the type of bacterial or virus you've been exposed to but may include:

• Stomach cramps
• Tenesmus , feeling you need to have a bowel movement even when your bowels are empty
• Mucous in stool

More severe cases of traveler's diarrhea may cause bloody stools .

Should You Go to a Doctor for Traveler's Diarrhea?

See a healthcare provider if your symptoms are accompanied by fever or bloody stools, or they last longer than 48 hours.

Traveler's Diarrhea Causes

The most common cause of traveler's diarrhea is probably poor hygiene (lack of cleanliness) in restaurants. You're most at risk when dining out in areas of Asia, the Middle East, Mexico, Africa, and South and Central America.

Pathogens are usually spread via the fecal-oral route . This means someone with the bacteria or virus excretes the germs in their feces. The feces may not be safely disposed of in a sanitary setting, or the infected person may not properly wash their hands before handling food and beverages. This allows germs to be transmitted to something you put into your mouth.

This cycle of contamination is most common in areas of the world that have specific conditions:

• Warmer climates that promote germ growth
• Poor sanitation (such as open sewage areas)
• Unreliable refrigeration
• Little education on safe food handling.

Common Bacterial Pathogens

The most common cause of traveler's diarrhea is bacteria, which are thought to lead to 80% to 90% of cases. These include:

• Escherichia coli or E-coli
• Campylobacter jejuni

Ingesting these bacterium causes gastroenteritis , which means the stomach and small intestines become inflamed. This leads to diarrhea.

Common Viral Pathogens

Viruses can also be transported via the fecal-oral route. The most common types of viruses that cause diarrhea include:

Viral infections of the digestive system are often referred to as stomach flu . The illness has no connection to respiratory influenza, but like the "flu," it usually lasts a short period.

Other Causes of Diarrhea

In addition to germs in your food and water, you could develop diarrhea from toxins, which cause the common symptoms of food poisoning .

Parasites , or protozoal pathogens, can also cause diarrhea. In these instances, you're more likely to develop symptoms one to two weeks after exposure to the pathogen.

Dehydration is one of the most common complications related to any form of diarrhea. Multiple bowel movements that release a lot of fluid can cause you to have too little water in your body.

Severe dehydration can lead to problems such as:

• Fatigue and muscle weakness or pain
• Dizziness or lightheadedness
• Increased heart rate and breathing
• Kidney Failure

Dysentery is a serious condition that can develop from exposure to Shigella or parasites. It usually causes bloody stool, fever, and extreme dehydration. It can be fatal if it's left untreated. In addition to being picked up from contaminated food or water, the bacteria or parasites that cause dysentery can be passed from person to person in close contact, or you can get it by swimming in unclean water.

Treatment for Traveler's Diarrhea

Getting sick while far from home is more than just inconvenient. The sudden onset and severity of symptoms can be frightening. Often, symptoms will last a few days and resolve on their own, but you may need to manage the condition and take medication.

Fluid Replacement

To manage dehydration, you want to concentrate on getting enough liquids even if you feel like you don't want to put anything in your stomach.

Drinking any safe fluids can manage mild cases of traveler's diarrhea. Since tap water may be a source of infection, you need to boil non-bottled water and let it cool before you drink it. You can also drink boiled broth or prepackaged (non-citrus) fruit juice. Sports drinks like Gatorade are good, too, but not essential.

For severe dehydration, an oral rehydration solution may be needed. These are mixes or packaged beverages that contain glucose and electrolytes such as potassium and sodium. Pedialyte is an example of an oral rehydration solution for kids.

Sweating can cause dehydration as well. Try to find a cool place out of the sun to rest while you rehydrate.

Antibiotics

Antibiotics may be used for traveler's diarrhea caused by bacterial infections. A stool test should be done to identify which antibiotic might work best.

Quinolone antibiotics such as Cipro (ciprofloxacin) are most often used when antibiotics are needed.

A single dose of 750 milligrams (mg) for adults is the typical treatment. Children may be given 20 to 30 mg per kilogram of weight per day.

In some areas, bacteria are resistant to quinolones, which means the medication won't help. This is especially a problem in Southeast Asia. Another antibiotic, azithromycin , may also be used in this case, although some strains are resistant to it.

Upset Stomach Medication

Pepto-Bismol can provide short-term relief of symptoms. However, it may not be effective in small doses, and high doses put you at risk for a health condition called salicylate toxicity. Additionally, Pepto-Bismol is not recommended for people younger than 18 years because there's a risk of a condition called Reye's syndrome .

Antidiarrheal Agents

It might seem logical to reach for an anti-diarrheal product such as Imodium (loperamide) or Lomotil (diphenoxylate). However, these products should not be used if your diarrhea is related to dysentery or if you see any signs of blood in your stools.

An antidiarrheal agent should only be taken with an antibiotic. When using an antidiarrheal for traveler's diarrhea, it is especially important to keep yourself well-hydrated. Discontinue the product if your symptoms worsen or you still have diarrhea after two days.

How Long Traveler's Diarrhea Lasts

Most cases of traveler's diarrhea last from one to five days. However, symptoms may linger for several weeks.

To help prevent traveler's diarrhea:

• Wash your hands with soap and water after going to the bathroom and before eating.
• At restaurants, only eat foods that are cooked and served hot.
• Drink beverages from factory-sealed bottles or containers.
• Don't get ice in your drink since it may be made with contaminated water.

There is evidence that Pepto-Bismol may protect against traveler's diarrhea. Studies have shown a protection rate of about 60%. However, not everyone should take Pepto-Bismol, including those who are pregnant or are 18 years of age and younger.

Don't take antibiotics or antidiarrheal medicine like Pepto-Bismol as prophylaxis—that is, to prevent traveler's diarrhea— unless it's been recommended to you by your healthcare provider.

Bacteria and viruses can live in water and food. These pathogens (germs) are most common in areas where the climate is warm, refrigeration is unreliable, and there isn't proper hand washing or bathroom sanitation. Infection with these pathogens (bacterial or viral) can cause traveler's diarrhea.

Traveler's diarrhea will often resolve on its own once the bacteria or virus is out of your system. However, you may need antibiotics. You may also need to manage symptoms by staying hydrated and using over-the-counter medications. You should contact your healthcare provider if symptoms last more than a few days.

When traveling to regions that have warm climates and relaxed hygiene practices, be sure to take steps to avoid eating or drinking anything that could have pathogens. Drink pre-packed or boiled water and ensure food is handled properly.

It's important to make sure that your child gets enough fluids. Diarrhea can lead to dehydration more quickly in kids than in adults. Check with your healthcare provider if your child has signs of dehydration such as dry mouth, few or no tears when crying, irritability, reduced urination, and drowsiness.

If you're pregnant, the most important thing to do is to drink enough fluids so you don't get dehydrated. Your doctor may suggest using azithromycin if you need an antibiotic. Don't use Pepto-Bismol (bismuth subsalicylate) when pregnant because of risks to the growing fetus.

Connor BA. Preparing international travelers: Travelers’ diarrhea . In: Brunette GW, ed. CDC Yellow Book 2020: Health information for international travel . Oxford University Press; 2017.

Leung AKC, Leung AAM, Wong AHC, Hon KL. Travelers’ diarrhea: a clinical review . Recent Pat Inflamm Allergy Drug Discov . 2019;13(1):38-48. doi:10.2174/1872213X13666190514105054

Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA.  Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics .  BMC Public Health . 2018;18(1):1346. doi:10.1186/s12889-018-6252-5

Strachan SR, Morris LF. Management of severe dehydration . Pediatr Crit Care Med . 2017;18(3):251-255. doi:10.1177/1751143717693859

Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report . J Travel Med . 2017;24(suppl_1):S57-S74. doi:10.1093/jtm/tax026

Johns Hopkins Medicine. Traveler's Diarrhea.

Nemours Foundation. KidsHealth. Staying healthy while you travel.

Morof DF, Carroll ID. Family travel: Pregnant travelers . In: Brunette GW, ed. CDC Yellow Book 2020: Health information for international travel . Oxford University Press; 2017.

Wanke, Christine A. " Travelers' Diarrhea ." UpToDate . 

By Barbara Bolen, PhD Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.

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• Section 11 - Respiratory Infections
• Section 11 - Dermatologic Conditions

Persistent Diarrhea in Returned Travelers

Cdc yellow book 2024.

Author(s): Bradley Connor

Although most cases of travelers’ diarrhea (TD) are acute and self-limited, a certain percentage of people afflicted will develop persistent (>14 days) gastrointestinal (GI) symptoms. Details on the management of acute TD are available in Sec. 2, Ch. 6, Travelers’ Diarrhea .

Pathogenesis

The pathogenesis of persistent diarrhea in returned travelers generally falls into one of the following broad categories: ongoing infection or co-infection with a second organism not targeted by initial therapy; previously undiagnosed GI disease unmasked by the enteric infection; or a postinfectious phenomenon.

Ongoing Infection

Most cases of TD are the result of bacterial infection and are short-lived and self-limited. In addition to immunosuppression and sequential infection with diarrheal pathogens, ongoing infection with protozoan parasites can cause prolonged diarrheal symptoms.

Individual bacterial infections rarely cause persistent symptoms, but travelers infected with Clostridioides difficile or enteroaggregative or enteropathogenic Escherichia coli (see Sec. 5, Part 1, Ch. 7, Diarrheagenic Escherichia coli ) can experience ongoing diarrhea. C. difficile –associated diarrhea can occur after treatment of a bacterial pathogen with a fluoroquinolone or other antibiotic, or after malaria chemoprophylaxis. The association between C. difficile and antimicrobial treatment is especially important to consider in patients with persistent TD that seems refractory to multiple courses of empiric antibiotic therapy. The initial work-up of persistent TD should always include a C. difficile stool toxin assay. Clinicians can prescribe oral vancomycin, fidaxomicin, or, less optimally, metronidazole to treat C. difficile .

As a group, parasites are the pathogens most likely to be isolated from patients with persistent diarrhea. The probability of a traveler having a protozoal infection, relative to a bacterial one, increases with increasing duration of symptoms. Parasites might also be the cause of persistent diarrhea in patients already treated for a bacterial pathogen.

Giardia (see Sec. 5, Part 3, Ch. 12, Giardiasis ) is the most likely parasitic pathogen to cause persistent diarrhea. Suspect giardiasis particularly in patients with upper GI–predominant symptoms. Untreated, symptoms can last for months, even in immunocompetent hosts.

PCR-based diagnostics, particularly the multiplex DNA extraction PCR, are becoming the diagnostic methods of choice to identify Giardia and other protozoal pathogens, including Cryptosporidium , Cyclospora , and Entamoeba histolytica . Diagnosis also can be made by stool microscopy, antigen detection, or immunofluorescence. In the absence of diagnostics (given the high prevalence of Giardia as a cause for persistent TD), empiric therapy is a reasonable option in the clinical setting. Rare causes of persistent symptoms include the intestinal parasites Cystoisospora , Dientamoeba fragilis , and Microsporidia .

Tropical Sprue & Brainerd Diarrhea

Persistent TD also has been associated with tropical sprue and Brainerd diarrhea. Tropical sprue is associated with deficiencies of vitamins absorbed in the proximal and distal small bowel and most commonly affects long-term travelers to tropical areas, as the name implies. The incidence of tropical sprue appears to have declined dramatically over the past 2 decades. Diagnosed only rarely in travelers, its cause is unknown.

Brainerd diarrhea is a syndrome of acute onset of watery diarrhea lasting ≥4 weeks. Symptoms include 10–20 episodes of explosive, watery diarrhea per day, fecal incontinence, abdominal cramping, gas, and fatigue. Nausea, vomiting, and fever are rare. Although the cause is believed to be infectious, a culprit pathogen has yet to be identified, and antimicrobial therapy is ineffective as treatment. Investigation of an outbreak of Brainerd diarrhea among passengers on a cruise ship to the Galápagos Islands in 1992 identified that individuals with persistent diarrhea (range: 7 to >42 months) were more likely to have consumed contaminated water or eaten raw fruits or vegetables washed with contaminated water.

Underlying Gastrointestinal Disease

Celiac disease.

In some cases, persistent symptoms relate to chronic underlying GI disease or to a susceptibility unmasked by the enteric infection. Most prominent among these is celiac disease, a systemic disease manifesting primarily with small bowel changes. In genetically susceptible people, exposure to antigens found in wheat causes villous atrophy, crypt hyperplasia, and malabsorption. Serologic tests, including tissue transglutaminase antibody testing, support the diagnosis; a small bowel biopsy showing villous atrophy confirms the diagnosis. Patients can be treated with a gluten-free diet.

Colorectal Cancer

Depending on the clinical setting and age group, clinicians might need to conduct a comprehensive search for other underlying causes of chronic diarrhea. Consider colorectal cancer in the differential diagnosis of patients passing occult or gross blood rectally or in patients with new-onset iron-deficiency anemia.

Inflammatory Bowel Disease

Idiopathic inflammatory bowel disease, including Crohn’s disease, microscopic colitis, and ulcerative colitis, can occur after acute bouts of TD. One prevailing hypothesis is that in genetically susceptible people, an initiating exogenous pathogen changes the microbiota of the gut, thereby triggering inflammatory bowel disease.

Postinfectious Phenomena

In a certain percentage of patients who present with persistent GI symptoms, clinicians will not find a specific cause. After an acute diarrheal infection, patients might experience a temporary enteropathy characterized by villous atrophy, decreased absorptive surface area, and disaccharidase deficiencies, which can lead to osmotic diarrhea, particularly after consuming large amounts of fructose, lactose, sorbitol, or sucrose. Use of antimicrobial medications during the initial days of diarrhea might also lead to alterations in intestinal flora and diarrhea symptoms.

Occasionally, onset of irritable bowel syndrome (IBS) symptoms occurs after a bout of acute gastroenteritis, known as postinfectious IBS (PI-IBS). PI-IBS symptoms can occur after an episode of gastroenteritis or TD. The clinical work-up for microbial pathogens and underlying GI disease in patients with PI-IBS will be negative. Whether using antibiotics to treat acute TD increases or decreases the likelihood of PI-IBS is unknown.

Traditional methods of microbial diagnosis rely on the use of microscopy. Examine stool specimens collected over 3 or more days for ova and parasites; include acid-fast staining for Cryptosporidium , Cyclospora , and Cystoisospora . Giardia antigen testing and a C. difficile toxin assay are appropriate elements of a work-up. In addition, a D-xylose absorption test can determine whether patients are properly absorbing nutrients. If underlying gastrointestinal disease is suspected, include serologic testing for celiac disease and consider inflammatory bowel disease during initial evaluation. Subsequently, studies to visualize both the upper and lower gastrointestinal tracts, with biopsies, might be indicated.

Diagnostic tests to determine specific microbial etiologies in cases of persistent diarrhea have advanced in the past number of years. One of the most useful tools is high-throughput multiplex DNA extraction PCR. This technology uses a single stool specimen to detect multiple bacterial, parasitic, and viral enteropathogens simultaneously. Except for Cryptosporidium , these assays have high sensitivity and specificity; the clinical ramifications and the economic impact of using these diagnostic molecular panels have not been determined fully, however. In some cases, molecular testing detects colonization rather than infection, making it difficult for clinicians to interpret and apply the results properly.

Specific treatment of identified enteropathogens is usually indicated, and appropriate management of underlying gastrointestinal disease warranted (e.g., a gluten-free diet for celiac disease, medication for inflammatory bowel disease). Dietary modifications might help patients with malabsorption. Symptomatic treatment or the use of nonabsorbable antibiotics offer potential benefit if small intestinal bacterial overgrowth accompanies the symptom complex. Additionally, chronic diarrhea might cause fluid and electrolyte imbalances requiring medical management involving oral or intravenous replacement based on clinical presentation.

The following authors contributed to the previous version of this chapter: Bradley A. Connor

Bibliography

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Connor BA. Chronic diarrhea in travelers. Curr Infect Dis Rep. 2013;15(3):203–10.

Connor BA, Rogova M, Whyte O. Use of a multiplex DNA extraction PCR in the identification of pathogens in travelers’ diarrhea. J Trav Med. 2018;25(1):tax087.

Duplessis CA, Gutierrez RL, Porter CK. Review: chronic and persistent diarrhea with a focus in the returning traveler. Trop Dis Travel Med Vaccines. 2017;3(9):1–17.

Hanevik K, Dizdar V, Langeland N, Hausken T. Development of functional gastrointestinal disorders after Giardia lamblia infection. BMC Gastroenterol. 2009;9:27.

Libman MD, Gyorkos TW, Kokoskin E, Maclean JD. Detection of pathogenic protozoa in the diagnostic laboratory: result reproducibility, specimen pooling, and competency assessment. J Clin Microbiol. 2008;76(7):2200–5.

Mintz ED, Weber JT, Guris D, Puhr N, Wells JG, Yashuk JC, et al. An outbreak of Brainerd diarrhea among travelers to the Galapagos Islands. J Infect Dis. 1998;177(4):1041–5.

Norman FF, Perez-Molina J, Perez de Ayala A, Jimenez BC, Navarro M, Lopez-Velez R. Clostridium difficile –associated diarrhea after antibiotic treatment for traveler’s diarrhea. Clin Infect Dis. 2008;46(7):1060–3.

Porter CK, Tribble DR, Aliaga PA, Halvorson HA, Riddle MS. Infectious gastroenteritis and risk of developing inflammatory bowel disease. Gastroenterology. 2008;135(3):781–6.

Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology. 2009;136:1979–88.

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Why travel screws with your stomach & how to help.

by Colleen_Stinchcombe

Colleen_Stinchcombe

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“In general, I think the most common things that people get are upset stomach, bloated and constipation,” she says. Diarrhea can also occur — you may have heard of traveler’s diarrhea — but it’s usually related to an infection rather than general traveling.

Why does this happen?

“That in and of itself can just change the whole dynamic of the GI tract,” she says. Travel, especially by airplane, can also lead people to get dehydrated (I mean, who hasn’t sipped water sparingly so they don’t have to climb over their seat mate ask to get up for the lavatory?), which can lead to constipation.

These two things — a change in schedule and dehydration — are the main culprits, according to Cohen. It certainly doesn’t help that people who travel are often eating differently than they do at home. Whether it’s eating more carb- and fat-heavy foods or eating larger portions than normal, our gut is thrown for a bit of a loop. That can lead to constipation and other GI upset too. Cohen adds, “It kind of shifts the system.”

Sometimes you can experience what’s called traveler’s diarrhea, which reports say affects 40 to 60 percent of travelers.  Some cases are due to bacteria from food or water that causes illness, and may take a few days of your trip to recover from.

What can you do?

So, are your vacations doomed to gastrointestinal distress forever? Not necessarily. Cohen says there are several steps you can take to relieve the most common symptoms.

First, it must be said that if you’re already on a regimen to help alleviate constipation and bloating at home, continue that when you travel, she said. “You shouldn’t just stop because you’re going away,” she notes.

More: Can Using a Fitbit Have a Long-Term Impact on Your Health?

If you don’t have gut issues at home but do when you travel, Cohen recommends getting ahead of the issue. Before, during and after the trip, drink more water and eat more fiber-rich fruits and vegetables. Apples, bananas, and nut bars with good fiber content can make great travel snacks, she says. If you mainly struggle with bloating, try not to eat larger portions than usual at mealtimes. If you’re still having issues, look for herbal options. “Peppermint, ginger, [and] fennel are helpful for bloating,” she says. Look for foods or drinks that contain them.

Exercise can also be key, especially if you’re already active at home. “Just like your heart needs exercise, your colon needs exercise,” Cohen explains. Between long flights or car rides and a packed itinerary, it can be easy to let movement go by the wayside. But you don’t have to do an intense workout routine to help relieve symptoms, she adds. Even a long walk can help to get the colon moving.

More: Self-Care Retreats to Help You Recharge

Still feeling uncomfortable? “If they know they get really constipated and diet isn’t enough, then sometimes I make sure they bring a gentle over-the-counter either fiber or laxative to have in hand in case it starts happening,” Cohen says. She recommends that her patients take a fiber assist or gentle laxative as soon as they start feeling symptoms rather than waiting until the problem is making them seriously uncomfortable.

If you’re prone to get traveler’s diarrhea, or are headed to an area where this can be common (such as Latin America, Southeast Asia, and the Caribbean ), it would benefit you to take a probiotic before and during your trip, and drink bottled water once you get to your destination as much as possible.

Ultimately, you should feel free to enjoy your wanderlust to the fullest, delicious local food included. Just give a little love to your gut along the way.

Before you go, check out these ways to stay hydrated during your trip:

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Traveler’s Diarrhea: How to Protect Yourself

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It’s probably the most unpleasant minor traveler’s malady. Unfortunately, it’s also probably the most common. Call it what you will — traveler’s tummy, Montezuma’s revenge, the traveler’s trot, the Toltec two-step, Delhi belly, the runs or the commonly accepted TD (for traveler’s diarrhea) — but don’t call it fun. Symptoms include diarrhea, stomach cramps, nausea and vomiting. Further, it can be dangerous, causing severe dehydration, malnutrition or worse.

The Centers for Disease Control and Prevention (CDC) reports that between 30 and 70 percent of international travelers suffer some form of TD. A vaccine against E. coli, the most common cause of traveler’s diarrhea, has been under development for more than a decade now — and there’s no sign that it will be released any time soon. Until then, here are our tips for preventing, identifying and treating traveler’s tummy.

What Causes Traveler’s Diarrhea?

A new diet, dehydration from flying, a change in climate, stress and even lack of sleep can cause simple traveler’s tummy. The most common cause of traveler’s diarrhea is bacteria, particularly E. coli, but many other microbes can lead to intestinal distress.

In most cases, traveler’s tummy is easily treated, a mere inconvenience in your travels. However, more serious ailments are possible, including dysentery, cholera, giardiasis and other intestinal disorders. See below for more on these conditions.

How to Avoid Traveler’s Diarrhea

Skip the ice cubes in your drink, pass on salads or other raw foods in developing countries, and seek out bottled water rather than drinking from the tap. For more tips on avoiding traveler’s diarrhea, read Food Safety: How to Avoid Getting Sick While Traveling and Drinking Water Safety .

Worldwide Risk Levels for Traveler’s Diarrhea

Note that in high-risk areas, it may be all but impossible to avoid some incidence of traveler’s tummy, even if you’re careful about what you eat and drink. Certain risk factors (such as worker hygiene in restaurants) are simply out of your control. Here’s a breakdown of your risks around the world:

High Risk: Most developing countries in Latin America, the Middle East, Africa and Asia

Intermediate Risk: Some Caribbean islands, some countries in Eastern Europe, South Africa, Argentina and Chile

Low Risk: The United States, Canada, Northern and Western Europe, some countries in Eastern Europe (including Poland and Slovenia), New Zealand and Australia

For more details, check out the CDC’s destination-specific health information .

Identifying Traveler’s Diarrhea

As outlined above, symptoms can include diarrhea, stomach cramps, nausea and vomiting. These symptoms can be relatively severe, but should not persist for more than a few days, or become particularly violent. Even simple traveler’s tummy can be life-threatening under some conditions, so consider seeking medical attention if symptoms worsen or continue for more than 48 hours.

Common bacterial diarrhea usually sets in very rapidly and without warning and is not typically accompanied by bloody stools. About 80 to 90 percent of TD is considered bacterial diarrhea, according to the CDC.

There are other, arguably more serious maladies that cause similar or identical symptoms to common traveler’s diarrhea:

Amebiasis (amebic dysentery) : The appearance of blood or mucus in the stool is a sign of potential dysentery. In this case, you should seek medical advice.

Giardiasis : This is a somewhat more complex intestinal disorder that can recur repeatedly for weeks after the conclusion of travel, as the protozoan that causes it has a longer incubation period than most bacteria. Symptoms include diarrhea, nausea, bloating, abdominal cramps and more, and may not appear until a week or two after the protozoan is introduced into your body. If you find yourself having repeated outbreaks of diarrhea even after your trip is over, or if your symptoms persist longer than a few days, seek medical attention.

Cholera : The appearance of severe, watery diarrhea spotted with mucus can be indicative of cholera. Other symptoms might include leg cramps and vomiting. It’s important for cholera sufferers to quickly replace their body’s lost water and salts to prevent dehydration. They may also need medical help.

Other conditions accompanied by fever, lethargy, persistent diarrhea lasting more than 48 hours, or severe diarrhea may require treatment with antibiotics and are cause for medical intervention.

Traveler’s Diarrhea Treatment

Symptoms of traveler’s tummy usually clear up on their own after a day or two. To speed your recovery, you’ll want to alter your diet. Staying hydrated is your first priority. Drink bottled fluids (such as water and Gatorade) and avoid caffeinated drinks such as soda, coffee and tea, as well as alcoholic drinks. Of course, you must use a clean water source. Oral rehydration salts can also help.

The most common treatment for traveler’s diarrhea is the use of bismuth subsalicylate (Pepto-Bismol), or the stronger loperamide (Imodium), but understand that these products merely relieve the symptoms and don’t actually provide a cure. In fact, in severe cases of abdominal distress, the tendency of these treatments to “block up” your digestive system can actually be counterproductive or dangerous.

These products may contain aspirin, and bismuth subsalicylate can cause a blackening of the tongue and stools, and occasionally ringing in the ears. These side effects disappear when treatment is discontinued.

Because most traveler’s diarrhea is caused by bacteria, antibiotics are generally effective. Two of the most common are ciprofloxacin, also known as Cipro, and levofloxacin. Once symptoms relent, you can discontinue taking the antibiotic; doctors indicate that you don’t have to see the treatment through a full cycle as with most antibiotics. If you’re headed to a developing country, you may want to ask your doctor to prescribe you a course of antibiotics to take along just in case.

These treatments are useful in the case of bacterial diarrhea, but not for amebic dysentery, viruses or food toxins. In fact, in these cases, you can make your infection worse. A simple rule: If there is blood in your stool, or if you have a fever, pass on these products and see a doctor.

When to Seek Medical Attention

If there is blood or mucus in your stool If you have a fever If symptoms persist for more than 48 – 72 hours If you cannot keep down light food or liquids

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Nothing brings a vacation to a screeching halt faster than a travel-borne stomach illness. Both the stress of traveling and changes to your regular diet play havoc on your digestive system and can bring on a myriad of stomach-related issues. Let’s explore some simple steps you can take to avoid travel stomach and arm you with proven tips to treat digestive problems if they do hit.

Be Prepared

When you travel to places where the climate or hygienic practices are not what your body is used to, or you want to sample the local cuisine, you have an increased risk of developing unpleasant digestive issues. As part of trip planning, the CDC encourages travelers to create a travel health kit for common medical emergencies. You should pack it in your carry-on bag and keep it with you all of the time. When it comes to traveler’s stomach, these items include oral rehydration salts for fluid replacement and OTC medications like Pepto Bismol or Imodium. You should also consult a doctor before your trip to get a prescription for an antibiotic you can take in case of diarrhea. Make sure you get guidance on when you should and should not take the medication. It could do more harm than good. You can also buy a travel-ready first-aid kit from Amazon for about $15 if you don't want to build one from scratch.

Some peoples get a traveler’s tummy because of the stress of the trip or a change in their routine or diet. But the most common culprit comes from an infectious agent like bacteria or parasites ingested after eating tainted food or drinking water. You can’t take your cue from locals who eat and drink because they have become accustomed to the bacteria and have built up an immunity to them.

How to Avoid Traveler's Stomach

There are simple ways to prevent traveler's tummy. The best way is to avoid exposure to the germs that cause this buzzkill of an illness. Here are some tips from the CDC and WHO that will help you avoid traveler's stomach all together:

·        Drink only beverages from sealed containers and pour them into a clean glass.

·        Don’t use ice cubes unless you can trust they came from clean water.

·        Only eat foods that are fully cooked and served hot.

·        Eat raw fruits and vegetables only if you can wash and peel them.

·        Avoid unpasteurized dairy products, including ice cream.

·        Wash your hands religiously with soap and water. If you can’t, use an alcohol-based hand sanitizer.

·        Keep your hands away from your mouth, eyes, and nose. This also helps you from getting a cold or the flu.

·        Live by this mantra—hydrate, hydrate, hydrate!

Proven Treatment

Even if you faithfully follow the steps to avoid digestive issues, you may still come down with the traveler’s stomach. It usually starts with a sudden attack of diarrhea with cramps, nausea, and/or vomiting (you may or may not have a fever). In most cases, it clears up on its own in a couple of days. Once you have identified your symptoms as a traveler’s stomach, you’ll need to replace the massive amounts of fluid and electrolytes you lost.

Staying hydrated is a crucial part of staying healthy while treating your stomach issues. Taking the anti-motility agents can help cut down on the trips to the bathroom, but they can also aggravate your feelings of dehydration, so again (it can’t be stressed enough), drinking loads of water is key to treating traveler’s tummy.

Here are the essential steps in treating traveler’s diarrhea:

·        Replace fluids with water and by using an oral rehydration solution . Avoid caffeinated drinks as well as alcohol.

·        Take over the counter anti-motility drugs (the most common are Pepto Bismol and Imodium)

·        Ensure you’re rested. Being stronger helps you battle any digestive issues. Taking a magnesium glycinate supplement can improve jet lag and promote relaxation and sleep while traveling.

·        If recommended by a health care provider, take a regimen of antibiotics. Two common medicines are ciprofloxacin and norfloxacin.

Following this treatment advice can help resolve symptoms within just a few days, so you can get back to enjoying your trip.

When to Seek Medical Help

If your condition is accompanied by a fever or tiredness or diarrhea persists for more than a couple of days, you might want to get some medical attention. Here are signs that you need to see a medical professional:

·        You can’t keep down light foods or liquids and have frequent vomiting.

·        Your symptoms linger for more than 48 hours.

·        You have a fever of over 102 F.

·        You have severe abdominal pain.

·        You have blood or mucus in your stool.

Note: This article offers only information and is not a substitute for the advice of a medical professional. If in doubt, always err on the side of caution.

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September 28, 2023

Why Do Airplane Flights Cause Digestive Problems?

The butterflies, and gas, in your tummy while you’re in flight might not just be from nerves

By Jocelyn Solis-Moreira

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If you get an upset, gassy stomach while traveling on planes, you’re not alone.

The average person passes gas 12 to 25 times a day , but when you’re on a plane, you might feel like you’re constantly breaking wind. In addition to feeling gassy, some may experience an increase in other stomach issues during air travel. Though scientists have yet to directly measure digestive changes in people traveling on commercial passenger airlines, high-altitude research has revealed some clues to what’s happening in the gut when you’re in flight.

As you ascend to higher altitudes, atmospheric pressure decreases . This change in pressure makes the air feel thinner because there’s less oxygen. Low air pressure and cold temperatures at these elevations cause the air to expand, spreading out molecules such as oxygen, nitrogen and argon, all necessary components of air. When the blood doesn’t carry sufficient oxygen to tissues, it causes hypoxia, says Harvey Hamilton Allen, Jr. , a gastroenterologist at Digestive Disease Medicine of Central New York. A reduced oxygen level in the body slows down the activity of digestive enzymes , which may contribute to problems with digestion. Research on hypoxia has also indicated several other gastrointestinal (GI) changes, from an upset stomach to more severe issues, such as bleeding in the bowels, Allen says.

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Fortunately, traveling in a plane isn’t the same as climbing to the top of Mount Everest, which stands at a lofty height of 29,029 feet . Though commercial airplanes soar a bit higher at an altitude between 31,000 and 42,000 feet , they contain cabin-pressure-control systems in which conditioned air simulates a pressure akin to that at 8,000 feet of altitude.

That change in cabin pressure can still make gas in your gut expand if you have food in your stomach. Think of how your ears pop when the plane quickly ascends or descends, says Rudolph Bedford , a gastroenterologist at Providence Saint John’s Health Center in California. Like the middle ear, the gut has air-filled cavities that widen to adjust to the sudden shift in pressure.

“Changes in cabin pressure and oxygen saturation, along with the vibration and motion of the plane, can inhibit gastric emptying,” Allen says. In other words, digested food can’t move to the small intestine, making it more difficult to do a number two. This can contribute to feeling bloated, gassy and nauseated.

The length of your flight matters as well. A one-hour flight won’t disrupt your gut as much as a 14-hour trip will. Spending most of your time sitting in a cramped seat can compress the abdomen and make it harder for food to pass through. Even if you maintain a good posture, sitting for long periods of time makes it harder for the expanded gas in the GI tract to escape. “Being less active slows down your intestinal motility, thereby exacerbating bloating and constipation,” says Sri Naveen Surapaneni , a gastroenterologist at Memorial Hermann Health System in Texas. Additionally, if you have heavy foods in your stomach, this could be problematic if the plane runs into any turbulence. Surapaneni says a bumpy ride could lead to nausea and vomiting for people prone to motion sickness.

Stress might also be a culprit in a gassy airborne stomach. Research has shown that the gut has a close relationship with the brain : people with flight anxiety release the stress hormone cortisol, which reduces blood flow and oxygen to the digestive system. The decreased blood flow, in turn, slows down the digestive system. “For many people with anxiety, getting on a plane and flying for long periods stimulates symptoms of bloating, cramping in their abdomen and the butterflies-in-their-stomach feeling,” Bedford says.

If you’re someone with a preexisting GI condition, such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) , gastroenterologists warn that flying can worsen your symptoms. Bedford says people with Crohn’s disease , a type of IBD, may have episodes of diarrhea, while people with IBS, a noninflammatory condition that causes abdominal discomfort and altered bowel movements, report frequent bloating, diarrhea and constipation. The increase in symptoms, Bedford says, is not typically caused by the flight itself but by the anxiety of flying. Flight anxiety and underlying stress from delays or unexpected changes to travel plans may cause many people’s IBS to flare up, he says.

The good news is you can take steps to prevent tummy troubles on your next flight. Gut experts recommend drinking a lot of water. “When you’re traveling, you’re usually not drinking as much, so you’re becoming dehydrated,” Allen says. The dry air and low air pressure in long flights is dehydrating . “Dehydration due to low humidity levels in the cabin can slow down digestion and worsen constipation and preexisting IBS symptoms,” Surapaneni explains. Consider bringing a refillable water bottle with you on the plane.

If you are eating before your flight, opt for a light meal that’s gentle on the stomach. This includes lean proteins and foods rich in fiber and healthy fats, such as salmon and Greek yogurt with berries. “You don’t really want to have processed foods or salty foods before getting on a flight,” Bedford says. He also encourages people to not eat at least 30 minutes before the flight. Eating earlier can help your stomach digest the food before boarding.

Once on the plane, you’re better off skipping the wine, coffee or carbonated drinks, which might worsen an already upset stomach. Surapaneni also advises to stay mobile when it’s safe to do so, whether that’s by standing up to take a stretch or walking around the cabin.

If you have a GI condition or are nervous about an upcoming flight, it’s always a good idea to consult with your doctor before boarding in case there are other remedies they would recommend. Also, don’t fret if you continue feeling some digestive issues after landing. These symptoms are temporary and usually pass in 24 to 48 hours, Bedford says.

So the next time you’re on a plane, if you’re a little gassier than usual, Bedford says, it’s better to release it rather than attempt to hold it in for an entire flight. “Move around and let it rip—hopefully not sitting next to somebody, if you can avoid it,” he adds.

How to prepare your stomach for international travel

Avoiding the dreaded traveller’s tummy and other digestive issues when going on vacation.

If you are anything like me, your vacation is something you plan for and look forward to all year. For it only to be spoiled by an upset stomach. Conditions such as Gastritis and IBS (Irritable bowel syndrome) can all be aggravated by flying, rich food, Anxiety and a different routine.

But there are ways that you can prepare your stomach for travel as well as protect it once you are there so that you can just lay back, relax, and enjoy that well-earned trip away.

Traveling with a sensitive stomach

I start preparing a week or so before we leave, I buy some good quality probiotics, which I take every morning. I am very strict with my diet, avoiding any foods that I know are a trigger for my gastritis. I also avoid alcohol and spicy foods, so that my stomach can be calm and at its best before I go.

If you are on medication for your digestive issues make sure you have packed enough to cover your holiday duration and a few days on either side, just in case of delays. It’s also a good idea to pack half in your suitcase and half in your hand luggage, in case you lose either bag.

Preparing your body for flying

Flying has always been an issue for me especially on long haul flights. I would feel ok whilst travelling, (although it would always make me gassy). But as soon as I got off the flight, I would get uncomfortable cramps for the rest of the day. Generally, only helped by having a lay down for an hour or so once I got to the hotel. I discovered that what I ate before and during the flight was having an impact on my gut and so now avoid certain foods and drink and it helped immensely.

Flying and food

Don’t overeat – Eating more smaller meals rather than one large one is much kinder to your digestive system. So don’t eat a huge meal at the airport. It better to eat light before the flight and take some healthy snacks on board to have later.

Eat plain food – As tempting as it is when you arrive at the airport with all those eateries smelling so good. Avoid anything too spicy, greasy, or overly processed.

Avoid gas producing foods – Steer clear of Beans, Broccoli, Brussel sprouts, cabbage, and lentils.

Avoid carbonated drinks – Such as Cola, Beer, and sparkling water.

Take your own – I tend to try and avoid aeroplane food these days and take my own or buy something at the airport that I know I tolerate well.

Keep hydrated – Drink lots of still water before and during the flight to avoid dehydration

Camomile tea – I always take my own tea bags and ask the flight attendant for a cup of hot water. It’s very soothing and relaxing on the stomach and helps keep me calm.

  It’s often thought that stomach issues are caused by the general stress of travelling but a recent study by the Swiss National Science Foundation (SNSF) has actually found it’s caused by a lack of oxygen, which can trigger inflammation in people who have issues with digestive issues such as IBD (inflammatory bowel disease). There isn’t much you can do to avoid this happening, but it may be possible for your Doctor to prescribe some medication to act as a preventative, so the stomach avoids becoming inflamed.

When you first arrive

It can be tempting to dive straight in with the cocktails and rich food, you are on holiday after all. But give your body time to recover from the flight. Don’t overeat on your first day and enjoy alcohol in moderation.

Keeping your stomach healthy

Eat fresh food – If you are cooking for yourself on holiday then try and get out to the markets and local shops and buy some fresh fruit, fish, meat, and vegetables and give yourself a break from hotel and restaurant food. Hotel and restaurants food is often more processed, full of salt and not as fresh as a home-cooked meal, so it’s good to mix it up a bit whilst your away.

Drink alcohol in moderation – I know this is hard for many, especially if you enjoy a drink or two when on holiday, but alcohol is very harsh on the stomach lining and after a few days of enjoying some Pina Coladas and ice-cold beers, you may not feel your best. Try to only drink alcohol with a meal.

Drink lots of water – Not only does this help your stomach it’s easy to forget to drink enough fluids when away from home and you can quickly become dehydrated. I like to use a Chilly’s bottle, or something similar when I am away. I fill it up with icy cold water and it stays that way all day, even in the hottest climates.

Supplements

 I use a few supplements when away to help protect my stomach lining and boost the healthy bacteria in my gut.

Probiotics – Travelling can really have a negative effect on the good bacteria in our guts. A mixture of different foods, alcohol and foreign bugs can wreak havoc on our digestive systems and upset the balance of good and bad bacteria. A good quality probiotic can help you recover quicker from a bout of diarrhoea and help rebalance your gut flora when you have had dodgy bacteria from food/water etc. There are lots of different ones out there, but for travelling, I use these as they don’t need to be refrigerated and so are ideal for hot climates. OptiBac for travelling abroad.

Slippery elm powder – I am never without slippery elm when travelling. It works by coating the stomach lining with its thick consistency and so helps Ito protect the stomach especially if you are eating and drinking foods that may irritate your stomach.

I take it 20 minutes before each meal and usually use the powder ( I always use this one – Indigo Herbs Slippery Elm Powder 100g) as I think it works better but I also take the capsules away with me as it’s not always convenient to mix the powder with water when out and about.

Psyllium husk – If constipation can be an issue for you then it’s a good idea to have some of this on standby. Constipation can easily happen on holiday as we often eat less fibre and can become slightly dehydrated, all things that can disrupt our usual routine. I will often sprinkle Psyllium husk on my cereal in the morning or mix it with a drink. They come in capsules too which can be easier. I use this one Psyllium Husks 500g in Storage Tub with Serving Scoop by Natural Health 4 Life

Wash your hands

We have all become better at this since Covid came into our lives but it’s still an important one to remember. Getting a stomach bug can completely ruin a holiday and so taking this simple measure might make all the difference.

I have a friend who goes on lots of cruises with her husband, they recently went on a small cruise along the Nile. She is scrupulous about cleaning her hands especially when away. A sickness and diarrhoea bug swept through the cruise, the only ones who didn’t get ill were her and her husband, she swears it was her thorough hygiene. I suppose we will never know for sure but it’s something to think about.

There are so many bugs and bacteria around when we are on holiday, touching surfaces, eating food from dubious places and our fellow holidaymakers all carry a risk. Washing your hands cuts down on that risk considerably. Try and wash them before you eat and after using the toilet at the very least. Hand sanitiser is particularly useful when on holiday.

Keep to your usual bathroom routine

It might be that you are out all day doing exciting activities and not following your normal routine, or maybe you are sharing a room with someone you don’t know that well and feel awkward about using the bathroom, but it’s important to find time to use the bathroom when you get that urge.

If you ignore the urge, you can become constipated, which can lead cause your whole digestive system having issues. Many people feel bloated and uncomfortable when they don’t go for a few days, which is not fun when you are on vacation. So, eat plenty of fibre, drink lots of water and try to stay in a routine.

Before I go away on holiday, I often get very stressed, packing for the family, taking the dogs to kennels, sorting out travel insurance, etc. It all can feel overwhelming, and I often find my stomach is uncomfortable, as stress is big a trigger for me.

So, I make sure I take some time to relax, even just half an hour the night before we leave. I might have a hot soak in a bubble bath or listen to some music. But just taking some time out from all the chaos can help avoid having digestive issues when away, as your body will feel calmer, and better able to cope with the stress of travelling.

Obviously when you are away it can be much easier to relax, and I strangely find if I have been having any digestive issues before I travel, they miraculously disappear when I arrive at my vacation destination.

I think being somewhere new, exploring, swimming in the ocean and just chilling out just stops me from focusing on my health as much and I seem to feel so much better.

Of course, I still need to be cautious about what I am eating and drinking but overall, I feel better than I do at home. So don’t stress too much about your issues, just be prepared and enjoy yourself.

Keeping a Calm Gut when travelling

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• Bloating After Flying: What Causes Jet Belly & How to Prevent it

Crammed into a middle seat on a crowded plane for a long-haul flight might have you counting the minutes until landing. 

You should feel relieved once you’re on the ground, but for a lot of frequent travelers, more discomfort comes after the flight in the form of bloating.

Bloating after flying, also known as “jet belly” or “airplane belly”, is a common travel side effect, and most people might just try to stomach the discomfort from the added gas in your digestive system. 

But understanding why bloating after flying happens and the best ways to prevent it can save you that same discomfort on your next trip. 

We’ve outlined the science behind bloating, its effects on your overall health and even have some tips for preventing bloating after flying all together. 

Article Guide

• Why Does “Jet Belly” Happen?
• Effects of Bloating on Your Health

How to Prevent Bloating After Flying

Best ways to relieve jet belly, take the pressure off by understanding why your body bloats, why does “jet belly” happen .

From take-off to landing, your body is constantly trying to adjust to changes it experiences while flying.

One of the biggest changes your body is adjusting to is the shift in atmospheric pressure. 

As the plane rises and descends, the air pressure inside the main cabin increases or decreases accordingly. In the meantime, your body is doing all it can to equalize the pressure in the cabin with the air pressure inside your body. 

Do you ever feel your ears pop during takeoff and landing? That common sensation is the air within your ear canal adjusting to match the air pressure of the main cabin. 

The same thing is also happening within your digestive system, which is one of the main causes of travel bloat. 

The air that naturally gathers within your intestines is now increasing and decreasing to make up for the cabin air pressure that changes based on the plane’s altitude.

Your Digestive System Under Pressure

As it tries to keep up with the changing altitude, your digestive system is doing its best to adjust to the excess gas that is filling your intestines.

This excess gas builds up during takeoff and increases until the plane reaches its cruising altitude. At this point, your body has done what it can to equalize the pressure inside and outside of your body so you might not notice the symptoms of bloating right away, especially if you’re on a long-haul flight. 

But when it comes time to descend for landing, your digestive system is set to release the excess gas it’s built up . 

As the plane starts to get closer to landing, you might feel the need to pass gas or belch, which is your body’s way of trying to get rid of the air it’s been holding onto for the flight. 

Airplane belly happens when your body doesn’t release all of the excess gas it accumulated throughout the duration of the flight. So even though you’ve landed at your final destination, you might not feel as relieved as you would like to be. 

Effects of Bloating on Your Health 

Your digestive system is hard at work on your flight so it’s important to understand the stress that bloating after flying has on your overall health.

Because you have excess gas taking up room inside of your intestines, bloating can be uncomfortable and take the form of stomach pain and issues passing gas. You may feel discomfort and notice minor swelling in your abdomen area as well. 

Luckily jet belly shouldn’t last more than one week after you land and can be relieved using different techniques and by taking natural supplements.

Even though excess gas will build in your body during the flight as a natural reaction to atmospheric pressure, you can still prevent the bloating you experience after flying.

By taking the time before and during your flight to follow these tips, you can help prevent the effects of that atmospheric pressure change can have on your body. 

#1. Watch What You Eat and When You Eat it

Just like jumping into the pool only 30 minutes after eating, you don’t want to jump into a flight on a full stomach. 

Your body is already working overtime to keep your gas levels in balance, so eating a big meal that's tough to break down before your flight only adds more stress to your already busy digestive system. 

Try packing plenty of healthy snacks that are easy to digest. Munching on healthy snacks throughout the long flight can help give your digestive system the support it needs while it's busy adjusting to changing atmospheric pressure. 

Some easy to digest, whole-food snacks that we recommend include: 

• Yogurt with granola and chia seeds
• Apples and peanut butter for dipping
• Homemade salad with dark, leafy greens
• Humus and whole grain crackers
• Nuts and berries 

Pacing yourself as you eat small snacks while the plane is at cruising altitude will also help give your digestive system time to break down food naturally and without any added stress.

#2. Pack Probiotics and Natural Supplements

Packing natural digestive aids can help prevent the effects of bloating by giving your digestive system the boost it needs while it’s constantly adjusting to the cabin pressure. 

Probiotics are a natural source of important bacteria that line the inside of your stomach and intestines. They help your body break down food so bringing probiotics along with your other vitamins in tablet form is a simple way to kick start the digestive process while you’re 35,000ft in the air. 

Bringing other natural supplements such as whole food powders can also help aid digestion because they contain powerful digestive enzymes. 

Papaya is a key ingredient in the FLIGHTFUD Flight Elixir and can help with bloating because it is a one of the best natural sources of digestive enzymes. 

Papaya is a rich source of the enzymes papain, chymopapain, caricain and glycyl endopeptidase that each aid in healthy digestion. 

#3. Stay Hydrated 

Drinking enough water during your flight is important for your overall health and can directly improve your digestive system. 

When you drink water, your body naturally filters out the extra sodium it might retain when it bloats after flying.

Having enough water to regularly use the restroom can ensure that your digestive system is working to flush out unwanted toxins and waste while inflight.

#4. Get Up and Move Around

Sitting for a long period of time, especially after eating, doesn’t give your digestive system much help when it comes time to break down food. 

The plane might be cramped, but if you take some time to shimmy out into the aisle for a quick walk it could help your digestive system speed up its natural process. 

Getting up from a seated position can help with circulation and can help your body release excess gas by releasing tension in your muscles. 

Even just standing for a few moments can help your body relieve any excess tension that can lead to bloating. 

#5. Think About Your Posture

It’s hard to get comfortable in your seat especially when legroom is scarce, but if you can be more mindful of how you sit in your seat, it can help prevent bloating. 

Sitting up right as opposed to slouching opens up more airways that can help you release the excess gas that is building up inside your intestines.

Investing in a business class seat on a long-haul flight is worth the extra purchase because most seats on larger aircrafts allow you to lay flat. 

Laying flat isn't just a luxurious way to get a good night's rest, it’s also worth the price to help relieve tension in your digestive system might cause bloating after flying.

It’s almost inevitable that you’ll experience some amount of travel bloat; it’s one of the many impacts of flying that your body undergoes. 

#1. Keep Drinking Water 

Drinking water might be the last you want to do because you feel full and bloated, but it’s one of the best things you can do to relieve the effects of bloating. 

Packing The Travel Water Bottle for your trip can help so that you always have water on hand even though your travels might get hectic. 

Be sure you stay hydrated even if it might feel initially uncomfortable so that your body continues to filter out the sodium that is causing you to retain water and bloat. 

#2. Exercise to Release Tension

There’s a lot of built up pressure in your abdomen from the excess gas, but a good way to relieve that tension is to loosen up with a little exercise. 

Going for a walk or taking a light run can relax your muscles to allow for gas to release freely. Light stretching and yoga are also calming ways to get your muscles warmed up so you can help get that excess gas out of your body.

#3. Natural Digestive Aids

If you forgot to take your vitamins on the plane, it’s still not too late to use natural supplements to aid in bloating.

The papaya in the Flight Elixir is a natural digestive aid that's filled with helpful enzymes that will are known to not only prevent but relieve the symptoms of bloating.

#4. Eat Fiber Rich Foods

Foods that are rich in fiber help your digestive system break down food and release unwanted toxins more freely. 

Leafy greens like kale, spinach and swiss chard are high in fiber and so are fruits like apples and berries.

 Eating a healthy diet of fiber rich foods at your final destination can help your get back to a regular gastrointestinal routine that can release the excess gas you’ve accumulated while flying.

Bloating after flying can make an already stressful trip even more uncomfortable. 

The last thing you want is to feel uncomfortable when you’re in a business meeting , or bloated when you’re trying to relax on the beach .

You want to be relieved when you reach your final destination so taking the time to prevent travel bloating can save you the stomach ache you might get on landing. 

Sarah Peterson

Sarah Peterson is the co-founder and head of marketing at FLIGHTFŪD. She's a travel health expert and after having visited 20+ countries as a digital nomad and flying every 4-6 weeks for business, she became passionate about empowering others to protect their bodies on the go.

Soooo helpful, makes so much sense, thank you so much for the info!!

Thank you SO much, Sarah!!!! Jesus Christ sent me here! Taking your Wisdom for traveling, I will stay my best Self & Shape!!

Wow! Thank you so munch. This was very informative.

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