By James J. O’Mailia, M.D., Gastroenterologist

TRAVELERS DIARRHEARecently, as most of you are aware, Flu Season was in full bloom here in Lee County. This included the dreaded Norovirus, which generally had its effect on many of the sea-faring cruise liners. Over the past several months, the common symptomatic presentation was that of diarrhea. Doctors’ offices, walk-in clinics and hospital emergency rooms received scores of distressing calls about this problem. And so, for this article, I want to introduce some basic ideas about what we, as physicians, want to know from you, our patients, about your symptoms to help you determine when to seek our advice, and some simple measures to help you weather what we call “Acute Diarrhea”.

More than any other gastrointestinal symptom, acute diarrhea – the kind that keeps you tentatively housebound and tethered to the bathroom – is an ordeal for which laws should be written.  Symptoms include surprise attacks of sudden urgency – no warning, just find a bathroom fast! This event can render a steady stream, or gaseous explosions. Other symptoms include persistent diarrhea with cramping or pain and with, seemingly, no end in sight, thereby forcing more fretful calls to doctors’ offices or surrendering to the emergency room.

By definition, acute diarrhea (as opposed to chronic diarrhea) is the sudden onset of frequent, loose and watery stools that are generally associated with urgency and cramping. In its worst presentation, the cramps can be so severe as to cause cold seats, nausea and the feeling that you don’t know which end of your digestive tract is about to heave. In other words, sufferers want relief NOW!

The causes of acute diarrhea are extensive. Here’s a short list: The well-known version involves minor bouts due to nervous stress or a change in one’s diet – and are usually short-lived and minimal in symptoms. Side effects of certain medications, Vitamin C and antibiotics can also be a cause. The most serious cause of sudden, abrupt diarrhea with cramping is usually an infection or a case of food poisoning.

The national organization, Center for Disease Control (CDC), has seen an upswing in the number of reported food poisoning cases per year, with many thousands of cases unreported. This is despite improvements in public health education and sanitation. The reasoning considered for this upswing is basically two-fold – and this includes both at the individual level and at the food manufacturing level – one: poor personal hygiene of food handlers and two: improper monitoring and storage of food. Although outbreaks from restaurants and fast food establishments are more of a media highlight, the truth is that most cases of food poisoning are caused simply by improper food handling and sloppy hygiene.

Another form of food poisoning is known as “Travelers Diarrhea”. Unfortunately, this is very common among American tourists visiting, for instance, the Caribbean/Mexico region, especially for an extended stay. That statistic is a frighteningly high 25%, or an estimated 3-5 million U.S. tourists per year just to that area alone. Globally, 45 million tourists traveling abroad suffer infectious food poisoning. And the numbers are rising, as more nomadic residents leave their relatively safe confines of home for exotic, remote destinations.

Acute diarrhea from food poisoning is no adventure. So, the obvious questions are “How can I avoid this?”, “What do I do if these symptoms develop?” and “When is professional medical care warranted?”

The first treatment goal is Prevention. Boil it, cook it, peel it or don’t eat it is a great motto. Follow this in even the fanciest of restaurants. If a food looks suspicious, send it back. Avoid salads, raw or undercooked meat and seafood, especially from street vendors. Stick with well-cooked foods and baked goods, canned goods, and fruits and vegetables washed or peeled by yourself.  Drink only factory-sealed bottled water, even to brush your teeth. Ice cubes with a central hole are safe since this type is made from water previously heated or boiled.

The second treatment goal is what to do if symptoms develop. The most significant problem is always dehydration. This would present itself as dry mouth, increased thirst, decreased and darkening urine, fast heart rate, and dizziness or a faint feeling. Immediately increase your fluid intake, even at the expense of solid foods – drink plenty of bottled water or Gatorade-type drinks to restore electrolytes. Sip fluids slowly, to prevent abdominal cramping. Eliminate any alcoholic beverages. If nauseous, try sipping a cold, but flat regular Coca Cola or ginger ale.

Once solids can be restarted, an old remedy – The BRATT Diet – is quite helpful. Simply put, this acronym stands for Bananas, Rice, Applesauce, Tea and Toast. These are complex carbohydrates that are easy to digest. Foods also include crackers, rice cereal, baked fish and yogurt. For awhile, stay away from fatty foods, such as pizza, burgers, fried foods and ice cream.

Don’t try to stop diarrhea immediately with medicines. Remember, diarrhea is the body’s way of eliminating the infection. However, if too severe or not controlled with increased fluids and diet restrictions, then over-the-counter medicines like Pepto-Bismol, Imodium AD or Kaopectate can be used. Just remember not to overdo it, as more medicine is not necessarily better therapy.

Finally, most cases of acute diarrhea are self-cured – using these points mentioned. However, never hesitate to contact your doctor if in doubt about your status. Should you develop severe, unrelenting abdominal pain, shaking chills, fever greater than 101 degrees, rectal bleeding, weakness or confusion – notify your doctor or seek medical care at a walk-in clinic or emergency room. The use of intravenous fluids or antibiotics can be determined by your doctors.  Never hesitate to seek professional medical advice if you aren’t sure of what treatment is needed. When treated early, acute diarrhea can usually be controlled relatively quickly and – the sooner the symptoms are controlled, the sooner the sunshine returns to your travelling adventure.

James J. O’Mailia, M.D., Gastroenterologist

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