travellers diarrhoea when to see a doctor

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Most cases of acute diarrhea go away without treatment. However, severe diarrhea (greater than 10 bowel movements a day or diarrhea where fluid losses are significantly greater than oral intake) can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems.

Seek medical attention for a child with these symptoms:

• Diarrhea that doesn't improve after 24 hours.
• No wet diaper in three or more hours.
• A fever of more than 102 F (39 C).
• Bloody or black stools.
• A dry mouth or tongue or cries without tears.
• Unusually sleepy, drowsy, unresponsive or irritable.
• A sunken appearance to the abdomen, eyes or cheeks.
• Skin that doesn't flatten if pinched and released.

Schedule a doctor's visit for an adult with these symptoms:

• Diarrhea lasts more than two days without improvement.
• Excessive thirst, dry mouth or skin, little or no urination, severe weakness, dizziness or lightheadedness, or dark-colored urine, which could indicate dehydration.
• Severe abdominal or rectal pain.

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• Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed April 27, 2023.
• Diarrheal diseases: Acute and chronic. American College of Gastroenterology. https://gi.org/topics/diarrhea-acute-and-chronic/. Accessed April 27, 2023.
• AskMayoExpert. COVID-19: Management and follow-up (adult). Mayo Clinic; 2021.
• Diarrhea. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/diarrhea. Accessed April 27, 2023.
• Khanna S (expert opinion). Mayo Clinic. May 13, 2021.
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Traveler's diarrhea

Learn how to avoid contaminated food and water that may lead to this common travel hazard. Plus, find out what to do if it strikes.

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.

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.

Traveler's diarrhea may get better without any treatment. But while you're waiting, it's important to try to stay hydrated with safe liquids, such as bottled water or water with electrolytes such as an oral rehydration solution (see below). If you don't seem to be improving quickly, several medicines are available to help relieve symptoms.

Anti-motility agents. These medicines — which include loperamide and drugs containing diphenoxylate — provide prompt but temporary relief by:

• Reducing muscle spasms in your gastrointestinal tract.
• Slowing the transit time through your digestive system.
• Allowing more time for absorption.

Anti-motility medicines aren't recommended for infants or people with a fever or bloody diarrhea. This is because they can delay clearance of the infectious organisms and make the illness worse.

Also, stop using anti-motility agents after 48 hours if you have stomach pain or if your symptoms worsen and your diarrhea continues. In such cases, see a doctor. You may need blood or stool tests and treatment with an antibiotic.

• Bismuth subsalicylate. This nonprescription medicine can decrease the frequency of your stools and shorten the length of your illness. However, it isn't recommended for children, pregnant women or people who are allergic to aspirin.
• Antibiotics. If you have more than four loose stools a day or severe symptoms, including a fever or blood, pus or mucus in your stools, a doctor may prescribe a course of antibiotics.

Before you leave for your trip, talk to your doctor about taking a prescription with you in case you get a serious bout of traveler's diarrhea.

Avoiding dehydration

Dehydration is the most likely complication of traveler's diarrhea, so it's important to try to stay well hydrated.

An oral rehydration salts (ORS) solution is the best way to replace lost fluids. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose to enhance absorption in the intestinal tract.

Bottled oral rehydration products are available in drugstores in developed areas, and many pharmacies carry their own brands. You can find packets of powdered oral rehydration salts, labeled World Health Organization (WHO)- ORS , at stores, pharmacies and health agencies in most countries. Reconstitute the powder in bottled or boiled water according to the directions on the package.

If these products are unavailable, you can prepare your own rehydrating solution in an emergency by mixing together:

• 3/4 teaspoon table salt.
• 2 tablespoons sugar.
• 1 quart uncontaminated bottled or boiled water.
• Sugar-free flavor powder, such as Crystal Light (optional).

You or your child can drink the solution in small amounts throughout the day as a supplement to solid foods or formula, as long as dehydration persists. Small amounts reduce the likelihood of vomiting. Breastfed infants also can drink the solution but should continue nursing on demand.

If dehydration symptoms — such as dry mouth, intense thirst, little or no urination, dizziness, or extreme weakness — don't improve, seek medical care right away. Oral rehydration solutions are intended only for urgent short-term use.

Lifestyle and home remedies

If you do get traveler's diarrhea, avoid caffeine, alcohol and dairy products, which may worsen symptoms or increase fluid loss. But keep drinking fluids.

Drink canned fruit juices, weak tea, clear soup, decaffeinated soda or sports drinks to replace lost fluids and minerals. Later, as your diarrhea improves, try a diet of easy-to-eat complex carbohydrates, such as salted crackers, bland cereals, bananas, applesauce, dry toast or bread, rice, potatoes, and plain noodles.

You may return to your normal diet as you feel you can tolerate it. Add dairy products, caffeinated beverages and high-fiber foods cautiously.

Preparing for an appointment

Call a doctor if you have diarrhea that is severe, lasts more than a few days or is bloody. If you are traveling, call an embassy or consulate for help locating a doctor. Other signs that you should seek medical attention include:

• A fever of 102 F (39 C) or higher.
• Signs of severe dehydration, including a dry mouth, muscle cramps, decreased urine output, dizziness or fatigue.

If you have diarrhea and you've just returned home from a trip abroad, share that trip information with your doctor when you call to make an appointment.

Here's some information to help you get ready, and what to expect.

Information to gather in advance

• Pre-appointment instructions. At the time you make your appointment, ask whether there are immediate self-care steps you can take to help recover more quickly.
• Symptom history. Write down any symptoms you've been experiencing and for how long.
• Medical history. Make a list of your key medical information, including other conditions for which you're being treated and any medicines, vitamins or supplements you're currently taking.
• Questions to ask your health care professional. Write down your questions in advance so that you can make the most of your time.

The list below suggests questions to ask about traveler's diarrhea.

• What's causing my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need?
• What treatment approach do you recommend?
• Are there any possible side effects from the medicines I'll be taking?
• Will my diarrhea or its treatment affect the other health conditions I have? How can I best manage these conditions together?
• What is the safest way for me to rehydrate?
• Do I need to follow any dietary restrictions and for how long?
• How soon after I begin treatment will I start to feel better?
• How long do you expect a full recovery to take?
• Am I contagious? How can I reduce my risk of passing my illness to others?
• What can I do to reduce my risk of this condition in the future?

In addition to the questions that you've prepared, don't hesitate to ask questions as they occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:

• What are your symptoms?
• When did you first begin experiencing symptoms?
• Have you traveled recently?
• Where did you travel?
• Have you taken any antibiotics recently?
• Have your symptoms been getting better or worse?
• Have you noticed any blood in your stools?
• Have you experienced symptoms of dehydration, such as muscle cramps or fatigue?
• What treatments have you tried so far, if any?
• Have you been able to keep down any food or liquid?
• Are you pregnant?
• Are you being treated for any other medical conditions?

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Traveller's diarrhoea

Peer reviewed by Dr Colin Tidy, MRCGP Last updated by Dr Toni Hazell Last updated 10 Feb 2023

Meets Patient’s editorial guidelines

In this series: Amoebiasis Giardia

Traveller's diarrhoea is diarrhoea that develops during, or shortly after, travel abroad. It is caused by consuming food and water, contaminated by germs (microbes) including bacteria, viruses and parasites. Other symptoms can include high temperature (fever), being sick (vomiting) and tummy (abdominal) pain. In most cases it causes a mild illness and symptoms clear within 3 to 4 days. Specific treatment is not usually needed but it is important to drink plenty of fluids to avoid lack of fluid in the body (dehydration). Always make sure that you get any advice that you need in plenty of time before your journey - some GPs offer travel advice but if yours doesn't then you may need to go to a private travel clinic.

In this article :

What is traveller's diarrhoea, what causes traveller's diarrhoea, are all travellers at risk, what are the symptoms of traveller's diarrhoea, how is traveller's diarrhoea diagnosed, when should i seek medical advice for traveller's diarrhoea, how is traveller's diarrhoea in adults treated, how is traveller's diarrhoea in children treated, side-effects of traveller's diarrhoea, how long does traveller's diarrhoea last, how can i avoid traveller's diarrhoea.

Continue reading below

Traveller's diarrhoea is diarrhoea that develops during, or shortly after, travel abroad. Diarrhoea is defined as: 'loose or watery stools (faeces), usually at least three times in 24 hours.'

Traveller's diarrhoea is caused by eating food, or drinking water, containing certain germs (microbes) or their poisons (toxins). The types of germs which may be the cause include:

Bacteria: these are the most common microbes that cause traveller's diarrhoea. Common types of bacteria involved are:

Escherichia coli

Campylobacter

Viruses: these are the next most common, particularly norovirus and rotavirus.

Parasites: these are less common causes. Giardia, cryptosporidium and Entamoeba histolytica are examples of parasites that may cause traveller's diarrhoea.

Often the exact cause of traveller's diarrhoea is not found and studies have shown that in many people no specific microbe is identified despite testing (for example, of a stool (faeces) specimen).

See the separate leaflets called E. Coli (VTEC O157) , Campylobacter, Salmonella, Cryptosporidium , Amoebiasis (dysentery information), Shigella and Giardia for more specific details on each of the microbes mentioned above.

Note : this leaflet is about traveller's diarrhoea in general and how to help prevent it.

Traveller's diarrhoea most commonly affects people who are travelling from a developed country, such as the UK, to a developing country where sanitation and hygiene measures may not meet the same standards. It can affect as many as 2 to 6 in 10 travellers.

There is a different risk depending on whether you travel to high-risk areas or not:

High-risk areas : South and Southeast Asia, Central America, West and North Africa, South America, East Africa.

Medium-risk areas : Russia, China, Caribbean, South Africa.

Low-risk areas : North America, Western Europe, Australia and New Zealand.

Sometimes outbreaks of diarrhoea can occur in travellers staying in one hotel or, for example, those staying on a cruise ship. People travelling in more remote areas (for example, trekkers and campers) may also have limited access to medical care if they do become unwell.

By definition, diarrhoea is the main symptom. This can be watery and can sometimes contain blood. Other symptoms may include:

Crampy tummy (abdominal) pains.

Feeling sick (nausea).

Being sick (vomiting).

A high temperature (fever).

Symptoms are usually mild in most people and last for 3 to 4 days but they may last longer. Symptoms may be more severe in the very young, the elderly, and those with other health problems. Those whose immune systems are not working as well as normal are particularly likely to be more unwell. For example, people with untreated HIV infection, those on chemotherapy, those on long-term steroid treatment or those who are taking drugs which suppress their immune system, for example after a transplant or to treat an autoimmune condition

Despite the fact that symptoms are usually fairly mild, they can often mean that your travel itinerary is interrupted or may need to be altered.

Traveller's diarrhoea is usually diagnosed by the typical symptoms. As mentioned above, most people have mild symptoms and do not need to seek medical advice. However, in some cases medical advice is needed (see below).

If you do see a doctor, they may suggest that a sample of your stool (faeces) be tested. This will be sent to the laboratory to look for any microbes that may be causing your symptoms. Sometimes blood tests or other tests may be needed if you have more severe symptoms or develop any complications.

As mentioned above, most people with traveller's diarrhoea have relatively mild symptoms and can manage these themselves by resting and making sure that they drink plenty of fluids. However, you should seek medical advice in any of the following cases, or if any other symptoms occur that you are concerned about:

If you have a high temperature (fever).

If you have blood in your stools (faeces).

If it is difficult to get enough fluid because of severe symptoms: frequent or very watery stools or repeatedly being sick (vomiting).

If the diarrhoea lasts for more than 5-7 days.

If you are elderly or have an underlying health problem such as diabetes, inflammatory bowel disease, or kidney disease.

If you have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, or HIV infection.

If you are pregnant.

If an affected child is under the age of 6 months.

If you develop any of the symptoms listed below that suggest you might have lack of fluid in your body (dehydration). If it is your child who is affected, there is a separate list for children.

Symptoms of dehydration in adults

Dizziness or light-headedness.

Muscle cramps.

Sunken eyes.

Passing less urine.

A dry mouth and tongue.

Becoming irritable.

Symptoms of severe dehydration in adults

Profound loss of energy or enthusiasm (apathy).

A fast heart rate

Producing very little urine.

Coma, which may occur.

Note : severe dehydration is a medical emergency and immediate medical attention is needed.

Symptoms of dehydration in children

Passing little urine.

A dry mouth.

A dry tongue and lips.

Fewer tears when crying.

Being irritable.

Having a lack of energy (being lethargic).

Symptoms of severe dehydration in children

Drowsiness.

Pale or mottled skin.

Cold hands or feet.

Very few wet nappies.

Fast (but often shallow) breathing.

Dehydration is more likely to occur in:

Babies under the age of 1 year (and particularly those under 6 months old). This is because babies don't need to lose much fluid to lose a significant proportion of their total body fluid.

Babies under the age of 1 year who were a low birth weight and who have not caught up with their weight.

A breastfed baby who has stopped being breastfed during their illness.

Any baby or child who does not drink much when they have a gut infection (gastroenteritis).

Any baby or child with severe diarrhoea and vomiting. (For example, if they have passed five or more diarrhoeal stools and/or vomited two or more times in the previous 24 hours.)

In most cases, specific treatment of traveller's diarrhoea is not needed. The most important thing is to make sure that you drink plenty of fluids to avoid lack of fluid in your body (dehydration).

Fluid replacement

As a rough guide, drink at least 200 mls after each watery stool (bout of diarrhoea).

This extra fluid is in addition to what you would normally drink. For example, an adult will normally drink about two litres a day but more in hot countries. The above '200 mls after each watery stool' is in addition to this usual amount that you would drink.

If you are sick (vomit), wait 5-10 minutes and then start drinking again but more slowly. For example, a sip every 2-3 minutes but making sure that your total intake is as described above.

You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if you are dehydrated.

Note : if you suspect that you are becoming dehydrated, you should seek medical advice.

For most adults, fluids drunk to keep hydrated should mainly be water. However, this needs to be safe drinking water - for example, bottled, or boiled and treated water. It is best not to have drinks that contain a lot of sugar, such as fizzy drinks, as they can sometimes make diarrhoea worse. Alcohol should also be avoided.

Rehydration drinks

Rehydration drinks may also be used. They are made from sachets that you can buy from pharmacies and may be a sensible thing to pack in your first aid kit when you travel. You add the contents of the sachet to water.

Home-made salt/sugar mixtures are used in developing countries if rehydration drinks are not available; however, they have to be made carefully, as too much salt can be dangerous. Rehydration drinks are cheap and readily available in the UK, and are the best treatment. Note that safe drinking water should be used to reconstitute oral rehydration salt sachets.

Antidiarrhoeal medication

Antidiarrhoeal medicines are not usually necessary or wise to take when you have traveller's diarrhoea. However you may want to use them if absolutely necessary - for example, if you will be unable to make regular trips to the toilet due to travelling.You can buy antidiarrhoeal medicines from pharmacies before you travel. The safest and most effective is loperamide.

The adult dose of this is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea up to a maximum of eight capsules in 24 hours. It works by slowing down your gut's activity.

You should not take loperamide for longer than two days. You should also not use antidiarrhoeal medicines if you have a high temperature (fever) or bloody diarrhoea.

Eat as normally as possible

It used to be advised to 'starve' for a while if you had diarrhoea. However, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able but don't stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food. Plain foods such as bread and rice are good foods to try eating.

Antibiotic medicines

Most people with traveller's diarrhoea do not need treatment with antibiotic medicines. However, sometimes antibiotic treatment is advised. This may be because a specific germ (microbe) has been identified after testing of your stool (faeces) sample.

Fluids to prevent dehydration

You should encourage your child to drink plenty of fluids. The aim is to prevent lack of fluid in the body (dehydration). The fluid lost in their sick (vomit) and/or diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids. However, avoid fruit juices or fizzy drinks, as these can make diarrhoea worse.

Babies under 6 months old are at increased risk of dehydration. You should seek medical advice if they develop acute diarrhoea. Breast feeds or bottle feeds should be encouraged as normal. You may find that your baby's demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds.

If you are travelling to a destination at high risk for traveller's diarrhoea, you might want to consider buying oral rehydration sachets for children before you travel. These can provide a perfect balance of water, salts and sugar for them and can be used for fluid replacement. Remember that, as mentioned above, safe water is needed to reconstitute the sachets.

If your child vomits, wait 5-10 minutes and then start giving drinks again but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.

Note : if you suspect that your child is dehydrated, or is becoming dehydrated, you should seek medical advice urgently.

Fluids to treat dehydration

If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. A doctor will advise about how much to give. This can depend on the age and the weight of your child. If you are breastfeeding, you should continue with this during this time. It is important that your child be rehydrated before they have any solid food.

Sometimes a child may need to be admitted to hospital for treatment if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a 'nasogastric tube'. This tube passes through your child's nose, down their throat and directly into their stomach. An alternative treatment is with fluids given directly into a vein (intravenous fluids).

Eat as normally as possible once any dehydration has been treated

Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not 'starve' a child with infectious diarrhoea. This used to be advised but is now known to be wrong. So:

Breastfed babies should continue to be breastfed if they will take it. This will usually be in addition to extra rehydration drinks (described above).

Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks (described above). Do not water down the formula, or make it up with less water than usual. This can make a baby very ill.

Older children - offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important consideration and food can wait until the appetite returns.

Loperamide is not recommended for children with diarrhoea. There are concerns that it may cause a blockage of the gut (intestinal obstruction) in children with diarrhoea.

Most children with traveller's diarrhoea do not need treatment with antibiotics. However, for the same reasons as discussed for adults above, antibiotic treatment may sometimes be advised in certain cases.

Most people have mild illness and complications of traveller's diarrhoea are rare. However, if complications do occur, they can include the following:

Salt (electrolyte) imbalance and dehydration .

This is the most common complication. It occurs if the salts and water that are lost in your stools (faeces), or when you are sick (vomit), are not replaced by you drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration is unlikely to occur, or is only likely to be mild and will soon recover as you drink.

Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, your kidneys may be damaged . Some people who become severely dehydrated need a 'drip' of fluid directly into a vein. This requires admission to hospital. People who are elderly or pregnant are more at risk of dehydration.

Reactive complications

Rarely, other parts of your body can 'react' to an infection that occurs in your gut. This can cause symptoms such as joint inflammation (arthritis), skin inflammation and eye inflammation (either conjunctivitis or uveitis). Reactive complications are uncommon if you have a virus causing traveller's diarrhoea.

Spread of infection

The infection can spread to other parts of your body such as your bones, joints, or the meninges that surround your brain and spinal cord. This is rare. If it does occur, it is more likely if diarrhoea is caused by salmonella infection.

Irritable bowel syndrome is sometimes triggered by a bout of traveller's diarrhoea.

Lactose intolerance

Lactose intolerance can sometimes occur for a period of time after traveller's diarrhoea. It is known as 'secondary' or 'acquired' lactose intolerance. Your gut (intestinal) lining can be damaged by the episode of diarrhoea. This leads to lack of a substance (enzyme) called lactase that is needed to help your body digest the milk sugar lactose.

Lactose intolerance leads to bloating, tummy (abdominal) pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the intestinal lining heals. It is more common in children.

Haemolytic uraemic syndrome

Usually associated with traveller's diarrhoea caused by a certain type of E. coli infection, haemolytic uraemic syndrome is a serious condition where there is anaemia, a low platelet count in the blood and kidney damage. It is more common in children. If recognised and treated, most people recover well.

Guillain-Barré syndrome

This condition may rarely be triggered by campylobacter infection, one of the causes of traveller's diarrhoea. It affects the nerves throughout your body and limbs, causing weakness and sensory problems. See the separate leaflet called Guillain-Barré syndrome for more details.

Reduced effectiveness of some medicines

During an episode of traveller's diarrhoea, certain medicines that you may be taking for other conditions or reasons may not be as effective. This is because the diarrhoea and/or being sick (vomiting) mean that reduced amounts of the medicines are taken up (absorbed) into your body.

Examples of such medicines are those for epilepsy, diabetes and contraception . Speak with your doctor or practice nurse before you travel if you are unsure of what to do if you are taking other medicines and develop diarrhoea.

As mentioned above, symptoms are usually short-lived and the illness is usually mild with most people making a full recovery within in few days. However, a few people with traveller's diarrhoea develop persistent (chronic) diarrhoea that can last for one month or more. It is also possible to have a second 'bout' of traveller's diarrhoea during the same trip. Having it once does not seem to protect you against future infection.

Avoid uncooked meat, shellfish or eggs. Avoid peeled fruit and vegetables (including salads).

Be careful about what you drink. Don't drink tap water, even as ice cubes.

Wash your hands regularly, especially before preparing food or eating.

Be careful where you swim. Contaminated water can cause traveller's diarrhoea.

Regular hand washing

You should ensure that you always wash your hands and dry them thoroughly; teach children to wash and dry theirs:

After going to the toilet (and after changing nappies or helping an older child to go to the toilet).

Before preparing or touching food or drinks.

Before eating.

Some antibacterial hand gel may be a good thing to take with you when you travel in case soap and hot water are not available.

Be careful about what you eat and drink

When travelling to areas with poor sanitation, you should avoid food or drinking water that may contain germs (microbes) or their poisons (toxins). Avoid:

Fruit juices sold by street vendors.

Ice cream (unless it has been made from safe water).

Shellfish (for example, mussels, oysters, clams) and uncooked seafood.

Raw or undercooked meat.

Fruit that has already been peeled or has a damaged skin.

Food that contains raw or uncooked eggs, such as mayonnaise or sauces.

Unpasteurised milk.

Drinking bottled water and fizzy drinks that are in sealed bottles or cans, tea, coffee and alcohol is thought to be safe. However, avoid ice cubes and non-bottled water in alcoholic drinks. Food should be cooked through thoroughly and be piping hot when served.

You should also be careful when eating food from markets, street vendors or buffets if you are uncertain about whether it has been kept hot or kept refrigerated. Fresh bread is usually safe, as is canned food or food in sealed packs.

Be careful where you swim

Swimming in contaminated water can also lead to traveller's diarrhoea. Try to avoid swallowing any water as you swim; teach children to do the same.

Obtain travel health advice before you travel

Always make sure that you visit your GP surgery or private travel clinic for health advice in plenty of time before your journey. Alternatively, the Fit for Travel website (see under Further Reading and References, below) provides travel health information for the public and gives specific information for different countries and high-risk destinations. This includes information about any vaccinations required, advice about food, water and personal hygiene precautions, etc.

There are no vaccines that prevent traveller's diarrhoea as a whole. However, there are some other vaccines that you may need for your travel, such as hepatitis A, typhoid, etc. You may also need to take malaria tablets depending on where you are travelling.

Antibiotics

Taking antibiotic medicines to prevent traveller's diarrhoea (antibiotic prophylaxis) is not generally recommended. This is because for most people, traveller's diarrhoea is mild and self-limiting. Also, antibiotics do not protect against nonbacterial causes of traveller's diarrhoea, such as viruses and parasites. Antibiotics may have side-effects and their unnecessary use may lead to problems with resistance to medicines.

Probiotics have some effect on traveller's diarrhoea and can shorten an attack by about one day. It is not known yet which type of probiotic or which dose, so there are no recommendations about using probiotics to prevent traveller's diarrhoea.

Further reading and references

• Bourgeois AL, Wierzba TF, Walker RI ; Status of vaccine research and development for enterotoxigenic Escherichia coli. Vaccine. 2016 Mar 15. pii: S0264-410X(16)00287-5. doi: 10.1016/j.vaccine.2016.02.076.
• Travellers' diarrhoea ; Fitfortravel
• 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 Apr 1;24(suppl_1):S57-S74. doi: 10.1093/jtm/tax026.
• Giddings SL, Stevens AM, Leung DT ; Traveler's Diarrhea. Med Clin North Am. 2016 Mar;100(2):317-30. doi: 10.1016/j.mcna.2015.08.017.
• Diarrhoea - prevention and advice for travellers ; NICE CKS, February 2019 (UK access only)

Article History

The information on this page is written and peer reviewed by qualified clinicians.

Next review due: 9 Feb 2028

10 feb 2023 | latest version.

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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

Connor BA. Sequelae of traveler’s diarrhea: focus on postinfectious irritable bowel syndrome. Clin Infect Dis. 2005;41(Suppl 8):S577–86.

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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Traveler's Diarrhea

• What is traveler’s diarrhea? |
• What are the symptoms of traveler’s diarrhea? |
• How can doctors tell if I have traveler’s diarrhea? |
• How do doctors treat traveler’s diarrhea? |
• How can I prevent traveler’s diarrhea? |

What is traveler’s diarrhea?

Traveler’s diarrhea is diarrhea (loose, watery poop) you get while traveling in areas of the world where the water has germs in it because it isn't treated (purified) properly. In these areas, you can get sick when you drink water, eat uncooked food, or eat food that was washed or made using water.

Bacteria like Escherichia coli ( E. coli ) in the water are the usual cause of traveler's diarrhea. But viruses like norovirus (especially on cruise ships) and other bacteria, viruses, and parasites can also cause it.

You get traveler’s diarrhea from bacteria, parasites, or viruses that are in the water you drink or on the food you eat

Symptoms usually start 12 to 72 hours after having consumed infected food or water and last for 3 to 5 days

You’re more likely to get traveler’s diarrhea when visiting countries where the water isn't purified well

To prevent traveler’s diarrhea, drink only bottled drinks, use bottled water to brush your teeth, and don't use ice cubes or eat uncooked fruits and vegetables

Go to the hospital if you have a fever or bloody diarrhea.

What are the symptoms of traveler’s diarrhea?

Feeling sick to your stomach

Throwing up

If you have a lot of vomiting and diarrhea, you'll get dehydrated and feel weak.

How can doctors tell if I have traveler’s diarrhea?

Doctors will ask about your symptoms. Doctors don’t usually test for traveler’s diarrhea. In some cases, they may take a sample of your stool (poop) to test it for bacteria, viruses, or parasites.

How do doctors treat traveler’s diarrhea?

Doctors will tell you to:

Drink plenty of fluids

Sometimes take antibiotics

Children under 2 years old and adults with a fever or bloody diarrhea shouldn’t take medicine to stop diarrhea.

If you have 3 or more loose stools over 8 hours, doctors may give you an antibiotic.

If tests find a parasite in your stool, doctors will give you medicine to treat the parasite.

How can I prevent traveler’s diarrhea?

Eat and drink only in restaurants known to have safe food—foods that are cooked and served hot are usually safe

If you want to eat fruit, eat only fruit that you peel yourself

Drink only bottled drinks or boiled water

Don't eat food from street vendors, buffets, and fast food restaurants

Don't eat salads with uncooked vegetables or fruit or salsa left on the table in open containers

Ask for drinks with no ice cubes, or make sure that ice cubes are made with water that has been boiled

Use bottled water to brush your teeth instead of local tap water

If you have a weak immune system , your doctor may give you an antibiotic to prevent traveler’s diarrhea.

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Traveler’s Diarrhea

• Diagnosis |
• Treatment |
• Prevention |
• More Information |

Traveler’s diarrhea is an infection characterized by diarrhea, nausea, and vomiting that commonly occur in travelers to areas of the world with poor water purification.

Traveler's diarrhea can be caused by bacteria, parasites, or viruses.

Organisms that cause the disorder are usually acquired from food or water, especially in countries where the water supply may be inadequately treated.

Nausea, vomiting, abdominal cramping, and diarrhea can occur with any degree of severity.

The diagnosis is usually based on the doctor's evaluation, but sometimes stool is tested for organisms.

Treatment involves drinking plenty of safe fluids and sometimes taking antidiarrheal medications or antibiotics.

Preventive measures include drinking only bottled carbonated beverages, avoiding uncooked vegetables or fruits, not using ice cubes, and using bottled water to brush teeth.

(See also Overview of Gastroenteritis .)

Traveler’s diarrhea occurs when people are exposed to bacteria, viruses, or, less commonly, parasites to which they have had little exposure and thus no immunity. The organisms are usually acquired from food or water (including water used to wash foods).

Traveler’s diarrhea occurs mostly in countries where the water supply is inadequately treated.

The bacteria Escherichia coli ( E. coli ) is the organism most likely to cause traveler’s diarrhea, particularly the types of E. coli that produce certain toxins , and viruses such as norovirus , which has been a particular problem on some cruise ships.

Travelers who avoid drinking local water may still become infected by brushing their teeth with an improperly rinsed toothbrush, drinking bottled drinks with ice made from local water, or eating food that is improperly handled or washed with local water. People who take medications that decrease stomach acid (such as antacids, H2 blockers, and proton pump inhibitors) are at risk of developing a more severe illness.

Symptoms of Traveler’s Diarrhea

The following symptoms of traveler's diarrhea can occur in any combination and with any degree of severity:

Intestinal rumbling

Abdominal cramping

These symptoms begin 12 to 72 hours after ingesting contaminated food or water. Vomiting, headache, and muscle pain are particularly common in infections caused by norovirus. Rarely, diarrhea is bloody.

Most cases are mild and disappear without treatment within 3 to 5 days.

Diagnosis of Traveler’s Diarrhea

A doctor's evaluation

Rarely stool tests

Diagnostic tests are rarely needed, but sometimes stool samples are tested for bacteria, viruses, or parasites, typically in people who have fever, severe abdominal pain, and bloody diarrhea.

Treatment of Traveler’s Diarrhea

Medications that stop diarrhea (antidiarrheal medications)

Sometimes antibiotics or antiparasitic medications

These medications are not given to children under 18 years of age with acute diarrhea. Antidiarrheal medications are also not given to people who have recently used antibiotics, who have bloody diarrhea, who have small amounts of blood in the stool that are too small to be seen, or who have diarrhea and fever.

Antibiotics are not necessary for mild traveler's diarrhea.

Antiparasitic medications are given if a parasite is identified in the stool.

Travelers are encouraged to seek medical care if they develop fever or blood in the stool.

Prevention of Traveler’s Diarrhea

Safe consumption of food and water

Travelers should eat only in restaurants with a reputation for safety and should not consume any food or beverages from street vendors. Cooked foods that are still hot when served are generally safe. Salads containing uncooked vegetables or fruit and salsa left on the table in open containers should be avoided. Any fruit should be peeled by the traveler.

Travelers should drink only bottled carbonated beverages or beverages made with water that has been boiled. Even ice cubes should be made with water that has been boiled.

Buffets and fast food restaurants pose an increased risk of infection.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Centers for Disease Control and Prevention (CDC): Choose Safe Food and Drinks When Traveling

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Know the Symptoms of Diarrhea and When to See a Doctor

Diarrhea is a common, unpleasant ailment that everyone suffers from at least occasionally. In the majority of cases, it will last a few days, but diarrhea that sticks around for weeks or longer can indicate a serious health problem requiring medical attention.

It’s important to know the signs of diarrhea in both adults and children, and when it's time to see a doctor.

Common Questions & Answers

• Pain or cramping in the abdomen
• An urgent need to go to the bathroom
• Anal irritation

If diarrhea is caused by an infection, people may also experience:

• Bloody stools
• Fever and chills

Diarrhea can lead to dehydration and malabsorption, each of which have their own symptoms.

6 Foods to Avoid When You Have Diarrhea

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Covid-19 and diarrhea, tests for diarrhea.

Most diarrhea goes away on its own in a few days. When diarrhea lasts for longer, tests are needed to find out what’s causing it so proper treatment can be administered.

A visit to the doctor for diarrhea will consist of a physical examination and a full medical history, including a review of your medication. A physician will also carefully feel your abdomen and may perform a rectal exam.

Additionally, testing for acute diarrhea may include:

If diarrhea persists, or if there are worrisome signs like bleeding, your doctor may order other tests, which include:

When to See Your Doctor

While occasional bouts of diarrhea are common and not cause for concern, diarrhea can become dangerous if it leads to severe dehydration. It can also signal an infection or a more serious health issue.

Visit your doctor right away if you experience any of the following symptoms:

• Diarrhea that lasts more than two days
• Diarrhea accompanied by a fever of 102 degrees F or higher
• Six or more loose stools in 24 hours
• Severe, unbearable pain in the abdomen or rectum
• Bloody stools or stools that are black and tarry or contain pus
• Diarrhea accompanied by frequent vomiting

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

• Symptoms & Causes of Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases.
• Diarrhea. Mayo Clinic.
• Malabsorption. Cleveland Clinic.
• Unusual COVID-19 Symptoms: What Are They. Mayo Clinic.
• Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. American Journal of Gastroenterology.
• Diarrhea Is Associated With Increased Severity of Disease in COVID-19: Systemic Review and Metaanalysis. SN Comprehensive Clinical Medicine.
• COVID Lon Haulers: Gastrointestinal Symptoms. Harvard University.
• Colonoscopy. Mayo Clinic.
• Symptoms & Causes of Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases . November 2016.
• Diarrhea.  Mayo Clinic . August 18, 2021.
• Malabsorption.  Cleveland Clinic . June 4, 2022.
• Unusual COVID-19 Symptoms: What Are They? Mayo Clinic . February 11, 2022.
• Han C, Duan C, Zhang S, et al. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. American Journal of Gastroenterology . April 15, 2020.
• Ghimire S, Sharma S, Patel A, et al. Diarrhea Is Associated With Increased Severity of Disease in COVID-19: Systemic Review and Metaanalysis. SN Comprehensive Clinical Medicine . January 6, 2021.
• COVID Long Haulers: Gastrointestinal Symptoms. Harvard University .
• Colonoscopy.  Mayo Clinic . May 18, 2022.

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How to avoid and treat travelers' diarrhea

Eating is a fun way to explore a place and culture, but it poses the risk of spending part of a trip doubled over after eating or drinking something contaminated by bacteria, viruses or parasites. Most people are exposed to some amount of contaminated foods, but travel often exposes us to new ones or higher doses that can defeat the immunity we have already built up. And it's not a rare occurrence — 30% to 70% of travelers come down with what's known as travelers' diarrhea, according to the Centers for Disease Control and Prevention.

What's worse is that a bout of diarrhea might not be the end of it. One in 10 cases of traveler's diarrhea develop into irritable bowel syndrome, a gastrointestinal disorder, according to Dr. Mark Pimentel, the executive director of the medically associated science and technology program at Cedars-Sinai in Los Angeles. An estimated 1 in 6 people in the United States experience IBS, with symptoms varying from constipation to nausea and ranging from mild to severe. It's a long-term condition with no known cure.

Much of the risk depends on where and when you travel, but Pimentel said some general precautions can keep most stomachs healthy and happy.

Sign up for the free daily TPG newsletter for more travel tips .

Mind the water

Contaminated water is a major source of bacteria that can sicken even the healthiest individuals. It's common in developing countries — you can check the CDC website to see if a particular destination has safe drinking water . If not, rely on bottled water for drinking and brushing your teeth. If you want to avoid plastic, there are reuseable water bottles with filtration built in that remove bacteria and viruses. While out and about, beware of ice cubes and drinks like smoothies that may have water or ice as a hidden ingredient.

Occasionally, restaurants refill water bottles locally and put new caps on. If that looks to be the case, order sparkling water, which can't be easily refilled. The carbonation is also acidic enough to kill bacteria. And there is always the option to skip water entirely and stick with soda, beer or wine, which Pimentel said are safe bets.

Related: How you can safely drink the tap water anywhere in the world

Avoid raw fruits and veggies

If you're in a place where water is an issue, fresh fruits and vegetables have to be chosen with care. If you are craving fruit, pick something you can peel so you remove the part that was washed with water. Fresh salads, while usually healthy, are filled with vegetables that get doused in local water. Consider this tip as a doctor's note to pick a greasier (and cooked) option.

Choose your street food wisely

For destinations like Mumbai and Bangkok with a rich street food culture, it's a shame to miss out on delicious regional eats. One tip from the late and great Anthony Bourdain is to follow the locals. Spots that rely on repeat customers instead of one-off tourists are places that need to keep people healthy.

Related: The cheapest Michelin-starred meals around the world

Pimentel also suggests looking for food that is extremely hot and well cooked. If you can, get the food right off the burner when it's hottest. And skip the garnishes, like herbs or fruits and veggies, which for the aforementioned reasons could be the Achilles' heel of an otherwise safe meal.

Start your caution on the plane

Being kind to your belly starts on the way to your destination if you're flying. The pressurization on a plane lets the gas in your gut build up and it can take hours to dissipate. If you want to get off the plane ready to travel and eat comfortably, skip foods that will make you gassy, like beans and processed carbs. Carbonated drinks like soda can also cause the gas to build up and should be avoided. Instead, stick with lean meats, nuts and vegetables such as lettuce, tomatoes, zucchini and avocados.

Related: It's not just you: Why everyone gets gassy and bloated on airplanes

Travel with supplies

Taking care of traveler's diarrhea early can help prevent IBS from developing, according to Pimentel. Before traveling, sensitive people should consult with a doctor who might prescribe antibiotics, like rifaximin and ciprofloxacin. The International Society of Travel Medicine has a list of travel clinics where people can search for a local option.

But it's not a bad idea for everyone to stock up on charcoal tablets, which can calm your digestive system and reduce gas, as well as something with bismuth in it like Pepto Bismol, which provides relief along with its antibacterial properties. One thing that doesn't work? Probiotics. They can cause bloating and distension, making you feel much worse.

Related: Rx for jail? What to know before taking your meds abroad

If it does happen, keep calm and hydrated

Despite best efforts, travelers can still pick up a bug. In that unfortunate event, it's important to stay hydrated , and for comfort, it's probably best to stick close to a bathroom. Many issues clear up after a day, but if it lasts more than a few days or there is blood in the stool, see a doctor.

Bottom line

Getting traveler's diarrhea is no fun, but there are steps you can take to avoid it. Depending on where you go, consider sticking with bottled water, skipping uncooked veggies and fruits, and when it comes to street foods, pick the hottest food available at the busiest stalls. If you are at a higher risk of getting sick, make sure to consult a doctor before going abroad. And if all else fails, take some time off and stay hydrated (with bottled water).

Breadcrumbs

• Traveler's diarrhea

Traveler's diarrhea

When people travel to faraway countries, their stomach and bowel often have to get used to new foods and new ways of preparing food. Diarrhea is common during travels to distant countries. Traveler's diarrhea typically only lasts a few days and usually doesn't need to be treated. There are certain things you can do to try to avoid getting it.

The risk of getting diarrhea is higher in countries with a hot and humid climate. There are a number of reasons for this. For instance, your stomach and bowel might have a hard time coping with unfamiliar foods such as spicy dishes and exotic ingredients. Poor hygiene, high temperatures and inadequate cooling of foods make it easier for bacteria to thrive in foods or water. Traveler's diarrhea is most often caused by bacteria . But viruses can also be transmitted through foods or water.

If diarrhea is severe or lasts a long time, it is particularly important to replace the lost fluids and salts. You should see a doctor if the symptoms don't improve or if you develop severe diarrhea within a few days or weeks of returning from travels to a distant country.

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Germs are often spread through foods or through contact with contaminated objects – for instance, if you touch a doorknob that has some germs on it with your hand, and then touch your mouth with your hand. So if you want to avoid getting diarrhea when traveling, it's especially important to wash your hands thoroughly and often. You should also avoid touching your face with your hands if you haven't washed them.

Depending on where you travel to, the following tips may help lower your risk of infection :

• Wash your hands regularly, especially before eating and after going to the bathroom. Have disinfectant wipes or gels at the ready in case it isn't possible to wash your hands while you're out and about. Dry your hands with disposable paper towels if available.
• Don't drink tap water. Instead, drink water from bottles or other containers, making sure the seal isn't broken when you buy them. Also avoid ice cubes and drinks that have been diluted with water.
• Use bottled water to brush your teeth and rinse your mouth.
• Do not drink water from fountains, wells, streams, rivers, springs, waterfalls or standing water.
• Only eat fruits, raw vegetables, lettuce and herbs if you peel them yourself or wash them thoroughly with bottled water.
• Don't eat undercooked meat or fish.
• Avoid contact with animals because they can also spread bacteria or viruses.
• Keep flies away from food.

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It is generally a good idea to find out which vaccinations are recommended in the country or part of the world you are traveling to before you go there. But there are currently no vaccinations against the germs that often lead to traveler's diarrhea.

People traveling to high-risk areas are advised to have a cholera vaccine. But this oral vaccine is only recommended if you're going to stay in a place with poor hygiene standards for a long time, or if you will be providing medical help in high-risk areas. People often say that the cholera vaccine can also reduce the risk of an ETEC infection . But there's no clear scientific proof that this is true.

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Some of the bacteria that travelers may come across in warm countries are also found in Western countries. These include Campylobacter and Salmonella bacteria . They can cause the following illnesses:

• ETEC infection : Enterotoxigenic Escherichia coli (ETEC) are spread through raw or undercooked foods, unpasteurized fruit juices or unpasteurized milk. The stool of cattle and other animals that chew the cud (e.g. goats, sheep) is a further potential source of infection . ETEC bacteria are sometimes found in bodies of water too. The symptoms break out three to ten days after infection . They usually include watery diarrhea, nausea, vomiting, abdominal pain and occasionally fever.
• Shigellosis , also known as bacillary dysentery or Marlow syndrome: Shigella bacteria are spread through contact with an infected person or by touching contaminated objects, as well as through contaminated water or foods. Flies can transmit Shigella bacteria too. The first signs of infection are usually watery diarrhea and abdominal cramps. They start about twelve hours to four days after becoming infected. In more serious cases, the bowel becomes inflamed, leading to a fever and diarrhea containing blood and pus.
• Cholera : The risk of getting cholera while on holiday in a distant country is very low. Cholera bacteria are spread through water, raw foods and the bodily secretions of infected people. They are rarely spread directly from one person to another. Symptoms start two to three days after infection , and include watery diarrhea and severe vomiting that can quickly lead to dehydration. Left untreated, cholera can become life-threatening.

Illnesses like typhoid and malaria, which are usually accompanied by a high fever, sometimes cause diarrhea too.

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The most common parasitic infection in tropical countries is giardiasis , also known as beaver fever. The second most common infection is cryptosporidiosis ("crypto"). The parasites (giardia and cryptosporidia) are spread through contact with infected people or contaminated objects, as well as through contaminated drinking water, foods and bodies of standing water.

Giardiasis symptoms start about one week after infection and include a feeling of pressure in the upper abdomen (belly), mild nausea and flatulence. The diarrhea is relatively mild but can continue for weeks, sometimes accompanied by vomiting. Patients often report loud gurgling sounds from their stomach, tiredness and weight loss.

Cryptosporidiosis can lead to watery diarrhea seven to ten days after infection . Further possible symptoms include abdominal pain, nausea, fever and weight loss. But the infection may also go unnoticed.

Which viruses can lead to diarrhea? Informationen about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Noroviruses and rotaviruses are found all over the world. One to three days after infection , the rotavirus often leads to sudden watery diarrhea, frequently mixed with mucus. This symptom is sometimes accompanied by vomiting, abdominal pain, and occasionally fever and breathing problems too. The infection usually lasts two to six days.

Norovirus symptoms start six hours to two days after infection and include severe diarrhea, violent projectile vomiting and abdominal pain. Further symptoms may include nausea, headaches, joint pain, exhaustion and a mild fever. The symptoms usually last two days at the most.

When is medication recommended? Informationen about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

If you have diarrhea and have a long journey ahead of you, for instance on a bus, loperamide or racecadotril can help reduce the symptoms. Both medicines should only be used in chidren after consulting a doctor. Low-dose racecadotril is available for children in the form of soluble granules, but only with a prescription. It is not routinely recommended for children under the age of five years.

If the diarrhea is caused by bacteria , antibiotics are often recommended. Studies have found that antibiotics don’t help against salmonella infections. It is still not clear whether these drugs help in the treatment of shigellosis or cholera.

Giardiasis is usually treated with antibiotics too. If you have cryptosporidiosis, making sure you get enough fluids is usually enough.

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When you have diarrhea, your body loses a lot of fluid and salts. Sweating in tropical temperatures makes this problem worse. So the most important thing is to drink as much as you can, and replace the lost salts and sugar. This is particularly true for babies, children and older people because they are more likely to become dehydrated compared to healthy adults.

People are often advised to buy oral rehydration solution at a pharmacy or drugstore and take it with them on their travels. Alternatively, you can make a solution yourself by adding the following ingredients to one liter of boiled or bottled water and stirring the solution:

• 4 teaspoons of sugar,
• ¾ teaspoon of salt and
• one glass of packaged orange juice.

Sometimes people recommend taking charcoal tablets or products made from a certain kind of yeast (Perenterol, Florastor). They are meant to make your poo more solid . There is not enough good research in this area to be able to say how well these products work, though. People who have a very weak immune system shouldn't take yeast products.

In order to go easy on your stomach and bowels, it can be a good idea to avoid fatty and spicy foods as well as alcohol and coffee. Foods that are gentle on the stomach are often recommended too, such as rice, bananas or rusk bread.

When do you need to see a doctor? Informationen about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

It is advisable to see a doctor if you have the following symptoms:

• Blood or mucus in your poo
• High fever, frequent vomiting, severe pain, dizziness or feeling faint
• Severe diarrhea that lasts longer than 48 hours, particularly in children and older adults
• Signs of dehydration (too little fluid in your body)

The signs of dehydration include:

• Worsening of general health
• Sunken eyes, cheeks or face
• Faster breathing or higher pulse than normal
• Less elastic skin : When you pinch some of the skin on the arm or belly and let go, it doesn't immediately bounce back to its original position. Instead, a small visible skin fold remains.
• Extreme thirst, feeling dizzy or faint, dark-colored pee or lack of urge to pee, as well as dry eyes or lips, or a dry tongue .
• Older people may sometimes have chest pain or muscle cramps.

Where can you find reliable health information for overseas travel? Informationen about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

The websites of the following institutions offer information and advice about diseases, vaccines, preventive measures and the treatment options (some of the information is only in German because we are a Germany-based website):

• German Federal Foreign Office
• Bernard Nocht Institute for Tropical Medicine
• World Health Organization (WHO)

Deutsche Gesellschaft für Tropenmedizin und internationale Gesundheit (DTG). Cholera . 2023.

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.

Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D et al. Hand-washing promotion for preventing diarrhoea . Cochrane Database Syst Rev 2021; (1): CD004265.

Gesundheitsdienst des Auswärtigen Amtes. Informationen für Beschäftigte und Reisende: Cholera . 2022.

Gesundheitsdienst des Auswärtigen Amtes. Merkblatt für Beschäftigte und Reisende: Durchfall (Diarrhoe) . 2018.

Gesundheitsdienst des Auswärtigen Amtes. Merkblatt für Beschäftigte und Reisende: Krankheitsprävention und Hygiene im Ausland (Kurzfassung). 2023.

Gordon M, Akobeng A. Racecadotril for acute diarrhoea in children: systematic review and meta-analyses . Arch Dis Child 2016; 101(3): 234-240.

Granados CE, Reveiz L, Uribe LG et al. Drugs for treating giardiasis . Cochrane Database Syst Rev 2012; (12): CD007787.

Hasso-Agopsowicz M, Lopman BA, Lanata CF et al. World Health Organization Expert Working Group: Recommendations for assessing morbidity associated with enteric pathogens . Vaccine 2021; 39(52): 7521-7525.

Imdad A, Mackoff SP, Urciuoli DM et al. Interventions for preventing diarrhoea-associated haemolytic uraemic syndrome . Cochrane Database Syst Rev 2021; (7): CD012997.

Leibovici-Weissman Y, Neuberger A, Bitterman R et al. Antimicrobial drugs for treating cholera . Cochrane Database Syst Rev 2014; (6): CD008625.

Liang Y, Zhang L, Zeng L et al. Racecadotril for acute diarrhoea in children . Cochrane Database Syst Rev 2019; (12): CD009359.

Onwuezobe IA, Oshun PO, Odigwe CC. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection . Cochrane Database Syst Rev 2012; (11): CD001167.

Robert Koch-Institut (RKI). Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2020 . Berlin: RKI; 2021.

Robert Koch-Institut (RKI). RKI-Ratgeber: Campylobacter-Enteritis . 2019.

Robert Koch-Institut (RKI). RKI-Ratgeber: Kryptosporidiose . 2019.

Robert Koch-Institut (RKI). RKI-Ratgeber: Norovirus-Gastroenteritis . 2019.

Robert Koch-Institut (RKI). RKI-Ratgeber: Rotaviren-Gastroenteritis . 2019.

Robert Koch-Institut (RKI). RKI-Ratgeber: Salmonellose . 2019.

Robert Koch-Institut (RKI). RKI-Ratgeber: Shigellose . 2021.

Robert Koch-Institut (RKI). Steckbriefe seltener und importierter Infektionskrankheiten . Berlin: RKI; 2011.

Robert Koch-Institut (RKI). Wann ist der Fall ein Fall? Neues zur Diagnostik von darmpathogenen Escherichia coli. Fortbildung für den öffentlichen Gesundheitsdienst . Berlin 26.-28.03.2014. 2014.

Sinclair D, Abba K, Zaman K et al. Oral vaccines for preventing cholera . Cochrane Database Syst Rev 2011; (3): CD008603.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods .

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We welcome any feedback and ideas - either via our form or by [email protected] . We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “ How can I find self-help groups and information centers? ”

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Updated on February 22, 2023

Next planned update: 2026

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Here’s When to See a Doctor About Diarrhea and When to Wait for It to Pass

By Korin Miller

When you’ve taken up permanent residency on your toilet thanks to diarrhea , you might start to wonder how normal your poop explosion really is. Sure, everyone has diarrhea from time to time, but when does it actually become a sign that you should see a doctor? Here, we consulted experts for the signals it’s time to seek treatment for diarrhea, plus what could be behind your butt’s excellent (and unfortunate) volcano impersonation.

By definition, diarrhea means having loose, watery, stools that are more frequent than whatever amount of pooping is normal for you, the Mayo Clinic says.

Quick biology lesson: When the stuff you eat reaches your small intestine where a lot of your digestion takes place, it’s usually in liquid form, Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF. Your small intestine and colon (which is the longest part of your long intestine) absorb most of the fluid, transforming that matter into the solid-ish poop you see in your toilet. But when you have diarrhea, something has interfered with your small intestine or colon’s ability to soak up that liquid, so you end up with the runny, watery poop that you know as diarrhea, Dr. Staller explains.

Why’s that? Well, having diarrhea for a couple of days is just something that happens sometimes.

You can generally lump diarrhea into two categories: acute and chronic. Acute diarrhea can last anywhere from a few days to two weeks and is usually due to a bacterial, viral, or parasitic infection, according to the Mayo Clinic . Sometimes that infection passes in a matter of days and is really nothing to worry about. That’s why if you have acute diarrhea that only lasts for a couple of days, you don’t have any weird symptoms along with it (we’ll get to what those symptoms are in a sec), and then it goes away, you should be fine to just stock up on toilet paper and roll with it, Ashkan Farhadi , M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF.

Chronic diarrhea, on the other hand, lasts for longer than four weeks at a minimum. That can point to serious issues like the inflammatory bowel diseases ulcerative colitis (a condition that causes inflammation and sores in your large intestine and rectum) and Crohn’s disease (another illness that causes inflammation in your digestive tract, but typically in your small intestine and colon), or irritable bowel syndrome , a chronic intestinal disorder that also affects your colon.

Here are signs you should, at the very least, give your doctor’s office a call for guidance:

If your diarrhea is still terrible after at least two days, it could be a sign that you have an infection that’s sticking around, Dr. Farhadi says. While a viral infection will just have to run its course (sorry, pal), you may need antibiotics to clear up a bacterial or parasitic infection, the Mayo Clinic says.

By Marygrace Taylor

By Julia Ries

By Theresa Tamkins

Having persistent diarrhea could also be a sign that a medication you’re on is upsetting your stomach or that something you’ve started eating regularly isn’t sitting well with you, Dr. Staller says. And, of course, long-lasting diarrhea could be a sign of one of the aforementioned conditions, like ulcerative colitis, Crohn’s disease, or irritable bowel syndrome , although you’ll typically have other symptoms as well, which we’ll cover further down the list.

Diarrhea can cause dehydration because you’re losing so much liquid. In severe cases, dehydration can be life-threatening if it’s not treated, according to the Mayo Clinic . But even if you don’t pass that threshold, being dehydrated feels awful and can be treated.

The biggest signs of dehydration to look out for: You’re incredibly thirsty, your skin and mouth are dry, you’re not peeing much or at all (plus your urine is a dark yellow color when you do actually pee), and you feel weak, dizzy , faint, or fatigued. If you have any of these signs along with your diarrhea, get to the emergency room , Dr. Farhadi says. You may need IV fluids to replace what you’ve lost.

When this happens along with diarrhea, doctors generally think of Crohn’s disease , Dr. Staller says. In addition to causing diarrhea, the inflammation that comes with Crohn's can create sores in your digestive tissue. “Crohn’s disease can affect anywhere in the GI tract, from the mouth down to the anus,” he explains. This is as opposed to ulcerative colitis, which is limited to your large intestine and rectum.

This can also be a sign of celiac disease, a condition in which eating gluten leads to an immune response in your small intestine, according to the Mayo Clinic . You might be tempted to chalk up your mouth pain to something like a canker sore , but if you’re also dealing with diarrhea, you should see your doctor to make sure something larger isn’t going on.

Severe stomach pain with diarrhea can signal many issues, from something as simple as gas to a potentially life-threatening condition like appendicitis , Christine Lee, M.D., a gastroenterologist at the Cleveland Clinic, tells SELF.

This could also be a sign of a more chronic condition like IBS-D (irritable bowel syndrome where diarrhea is the main symptom) or, again, Crohn’s disease or ulcerative colitis, Dr. Staller says. “Any diarrheal disease can cause pain,” he says, because diarrhea inflames and irritates the area. “The rectum has very sensitive nerves,” he adds.

Unless you happen to be a gastroenterologist, it’s going to be really hard for you to tell what’s behind this pain + diarrhea equation on your own. If you’re experiencing diarrhea and a lot of pain, a visit to the doctor is in order.

Pus is a yellow-ish, mucus-y liquid your body produces when trying to fight infection , Dr. Staller says. “It’s a marker of inflammation,” he explains, adding that the inflammation is part of your body’s immune response to whatever it has deemed a threat.

Diarrhea that contains pus is a common sign of ulcerative colitis, according to the Mayo Clinic . Those sores it creates in your gastrointestinal tract can lead to pus that comes out in your poop.

Blood in your poop could hint at a range of things. You could have a hemorrhoid (a clump of bulging veins in your rectum or around your anus), Dr. Lee says, but that typically causes only a bit of blood, not the kind that might set off alarm bells. It can also be a sign of a foodborne illness, the Mayo Clinic says. (For instance, Campylobacter bacteria is notorious for causing this, according to the Centers for Disease Control and Prevention .)

But, like with many other items on this list, this could be a sign that you have a chronic condition like ulcerative colitis or Crohn’s disease . When you have these conditions, your immune system may attack your GI tract to the point that it bleeds, Dr. Staller says. Either way, if a good portion of your poop is bloody or black (which hints at blood that has oxidized, so bleeding may be coming from higher up in your GI tract), you need to see a doctor right away, Dr. Farhadi says.

This generally indicates that you have some kind of infection that’s compromising your system, Dr. Lee says, although a fever can also be your body’s response to the inflammation that comes along with conditions like ulcerative colitis and Crohn’s disease. “Any time there is a fever and diarrhea, you should have your guard up,” Dr. Staller says. And, as you might guess, you should see your doctor.

In the meantime, you can try taking an over-the-counter fever reducer, but be sure to follow the instructions, since drugs like acetaminophen and ibuprofen can cause liver or kidney damage if you take too much, according to the Mayo Clinic .

Sure, if you’re pooping your brains out, you’re probably going to lose a little weight because of all those fluids whooshing out of you. But if your diarrhea won’t stop and you lose a few pounds (on top of your normal fluctuations) in a few days, it could be a sign that you’re dealing with an issue like a severe infection, inflammatory bowel disease, or celiac disease, Dr. Lee says. Either way, you want to make sure your doctor looks into it so they can address the root cause of your unintended weight loss.

They’ll likely do a blood test, stool test (where they try to figure out if a bacteria or parasite is causing your diarrhea), or colonoscopy or flexible sigmoidoscopy, procedures that look at the lining of your colon using a thin, lighted tube with a lens, according to the Mayo Clinic . After that, they can prescribe treatment.

If you’re dealing with diarrhea and you’re not sure what to make of it, call your doctor anyway, even if you don’t have the other symptoms on this list. “No one knows your body better than you, so trust your instincts,” Dr. Lee says. “If something doesn’t feel right, then get it checked out.”

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