I am a little over a month into my travels around West Africa and for the first time on this trip, I have experienced catastrophic, explosive diarrhea. This was inevitable - my eating habits have been reckless and I often purchase sachet water ("pure water" sold in 500ml bags for about 3 cents) that tastes like dirt.
This particular brand of diarrhea wakes you up in the middle of night and offers you a few seconds to find a toilet (or something toilet-like). If you make it to the toilet, you can find solace in that fact alone, because what happens while you are sitting on it is absolutely horrific. There is no relief, only terror, when pure fluid is coming out of your rear end. When you stand up, vertigo takes hold and you have a splitting headache. You realize that along with your life-force in general, you've also just pooped out your cranial fluid. You stagger back to bed - anything else is impossible.
So what do you do about it?
First, be proactive - travelers diarrhea is avoidable. If it's a fruit or vegetable, don't eat it unless it's cooked or you can peel it. Don't eat foods that are lukewarm, especially meat and dairy. Drink bottled water or water that you purify. Avoid ice. Unless you're in North America or Europe, steer clear of anything coming out of a well or a tap.
Many people will expand these guidelines in an attempt to preserve GI health. Even if you are exceptionally careful, however, you may still fall victim to traveler's diarrhea and you should be prepared to deal with it.
Before you leave, go to a travel clinic for a consultation and create an arsenal of the following items:
Oral rehydration salts - Travelers diarrhea can be miserable, but dehydration is really its only threat (unless you are seeing blood in your stool). You lose a lot of fluids when you have diarrhea and you can't just replenish them by drinking water alone. Oral rehydration salts are typically a combination of sodium and potassium chloride (salts) with glucose (sugar), both ingredients being necessary to effectively absorb water. You can find them at travel clinics, pharmacies and most camping/outdoor recreation stores. If you run out of them on the road, try to find a gatorade-like energy drink or powder. If you can't find that, put a teaspoon of salt and a teaspoon of sugar into a glass of water.
Pepto-Bismol - Will not get rid of the diarrhea, but will ease stomach and intestinal discomfort.
Imodium AD - "Controls the symptoms of diarrhea." What they mean to say is that it temporarily holds the diarrhea in your body. In other words, the destructive bacteria is still in your gut wreaking havoc.
Antibiotic - Depending on where you're going, you will most likely be prescribed Ciprofloxacin. It will be your most potent weapon. Cipro is an antiobiotic (the same used to treat anthrax poisoning in fact) that is akin to an atomic bomb. It will destroy everything in your system - good (as in beneficial bacteria in your gut) and bad.
When traveler's diarrhea strikes, follow these steps:
1) At the onset of diarrhea, look at your stool. If there is blood, get yourself to a clinic. If you can't get to a clinic, start taking antibiotic immediately.
2) Take note of additional symptoms. I once had a brutal bout of diarrhea and it was accompanied by an atrocious fever. Turns out I had malaria. If you have other symptoms (especially a fever), go to a clinic.
2) Begin rehydrating (with the rehydration salts) like its your job.
3) Try to avoid eating for one day. After a day, start eating BRAT foods (bananas, rice, apple sauce (unsweetened), plain toast).
4) The diarrhea may last several days. If possible, clear your schedule and just focus on rest, rehydration, and going to the bathroom.
5) Go to the bathroom as often as you need to do. Holding it in will only make the diarrhea last longer.
6) If you absolutely must do something absurd like take a 12 hour bus ride, bust out the Imodium and Pepto-Bismol. You must understand though, when you get off that bus, there will be hell to pay.
7) Did I mention rest and rehydrate?
8) If the diarrhea persists past two days without improving start taking the antiobiotic.
9) If the diarrhea does not improve within a day of taking the antiobiotic, go to a clinic.
Ideally, you will not encounter travelers diarrhea on your trip. Depending on where you are traveling, however, there is a good chance you will. These tips are designed to ease the misery and to restore your humanity as quickly as possible.
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