saudigastro.com/patients/travelers-diarrhea
Category
Common
Red flags
5
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Travellers' diarrhoea is a bowel infection picked up by eating or drinking contaminated food or water while travelling, usually in a place where sanitation or food handling differs from what your body is used to. It is defined as three or more loose stools in 24 hours with at least one other symptom such as cramps, nausea, vomiting or fever. It is most often caused by bacteria (especially certain types of E. coli), and less often by viruses or parasites.
How common is it?
It is the most common illness affecting travellers. The risk depends on the destination and the type of travel; it is higher in parts of South Asia, Africa and Central and South America, and in street-food and buffet settings. Short trips of a few days can be enough to catch it.
Why does it happen?
Germs get into the body through food or water that has been handled with unclean hands, washed in untreated water, kept too long at warm temperatures, or not cooked thoroughly. Ice cubes, raw salads, unpeeled fruit, shellfish, raw or undercooked meat and unpasteurised dairy are higher-risk. Travellers have little natural immunity to the local germs. Acid-lowering medicines (such as proton pump inhibitors) can slightly raise the risk, because stomach acid is a natural barrier to germs.
Symptoms
- Sudden loose or watery stools, often starting 1 to 3 days after arrival, sometimes after returning home
- Stomach cramps and bloating
- Nausea and sometimes vomiting
- Urgency to reach the toilet
- Low-grade fever and tiredness
- Dehydration: thirst, dark urine, dizziness
Red flags — seek urgent medical care
Blood in the stool, or high fever
May be a more invasive bacterial or parasitic infection. See a doctor promptly.
Signs of dehydration: very dark or little urine, dizziness when standing, fainting, confusion, or being unable to keep fluids down
Needs urgent medical care and possibly intravenous fluids, especially in hot climates, Hajj or Ramadan.
Diarrhoea lasting longer than 2 weeks, or weight loss
Suggests a parasitic infection (such as giardia) or another condition. Needs stool tests.
Severe or constant abdominal pain
Needs a medical assessment.
Fever after travel to a malaria-risk area, or illness in a child, an older adult, a pregnant woman or someone with a weak immune system
Seek medical care promptly and tell the doctor where you travelled.
How is it diagnosed?
Diagnosis is usually based on your symptoms and your travel history. Tell your doctor where you went, when symptoms started, what you ate and drank, and whether you took antibiotics recently. A stool test is done if the diarrhoea is severe, bloody, accompanied by high fever, or lasts more than about two weeks, or if a parasite or C. difficile infection is suspected. Blood tests help if you are dehydrated. If you have a fever after travelling to a malaria-risk area, you may be tested for malaria and other travel-related infections too.
Outlook — what to expect
Most episodes are short, lasting a few days, and settle without antibiotics. Replacing fluids keeps you safe while the body clears the infection. A small number of people have lingering bowel symptoms after the infection (post-infectious irritable bowel syndrome), which can be treated.
Treatment
Habits & Lifestyle
Prevention is mostly about careful choices with food, water and hands, and being prepared before you go.
- Wash hands with soap and clean water before eating and after the toilet. Use an alcohol-based hand gel (at least 60 percent alcohol) when soap and water are not available.
- Pack oral rehydration salts (ORS) sachets, hand gel, paracetamol and any regular medicines in your hand luggage.
- Drink only sealed bottled water, boiled water, or properly treated water. Use it also for brushing teeth. Check that the bottle cap seal is intact.
- At Hajj, Umrah and other mass gatherings, avoid food that has been standing in the heat, choose freshly cooked hot meals, and keep your own water and snacks protected from heat.
- Ask your doctor before travel about vaccines for your destination and whether a standby plan is suitable for you. Do not start antibiotics by yourself without having discussed it.
Diet
"Boil it, cook it, peel it, or leave it" is a useful rule. While ill, fluids come first.
- Eat food that is freshly cooked and served hot. Be cautious with buffets, salad bars, street food that has been kept warm for hours, and anything raw.
- Choose fruit you peel yourself. Avoid ice cubes, unpasteurised milk and juices, and raw shellfish.
- When you have diarrhoea, drink ORS in small, frequent sips and add more after each loose stool. Eat light, plain food (rice, bread, bananas, potatoes) as soon as you feel able.
- Avoid alcohol, very greasy or spicy food and large amounts of caffeine until you recover.
Medications
Fluids are the main treatment. Antibiotics help only in selected moderate or severe cases and should be prescribed by a doctor. Medicine choice depends on where you travelled, your health and your pregnancy status.
- Antibiotics are not needed for mild illness. They can cause side effects, may encourage antibiotic-resistant germs and may lead to colonisation of the bowel with resistant bacteria that can be carried home. Never take them to prevent diarrhoea.
- Discuss a standby plan with a doctor before you travel, especially if you have bowel disease, a weak immune system, diabetes, kidney disease or are travelling somewhere remote. The doctor will advise if, which medicine and when.
- Loperamide may be used for short-term relief in healthy adults with watery diarrhoea only. Do not use it in children, or if there is blood in the stool or fever, unless advised by a doctor.
- If you take acid-reducing medicines, ask your doctor whether you still need them while travelling. Do not stop them without advice.
Procedures & Surgery
No procedures are normally needed. Hospital care is for dehydration or serious infection.
- Stool tests when symptoms are severe, bloody or prolonged.
- Intravenous fluids in hospital for severe dehydration.
Living with the condition
- See a doctor if diarrhoea continues after you get home, even if you feel better in other ways. Mention your travel.
- If you are on treatment for bowel conditions such as inflammatory bowel disease, discuss travel plans, vaccines and a sick-day plan with your specialist early.
- Keep your hands clean when you return so you do not pass an infection to your family.
In the Saudi context
Pilgrims at Hajj and Umrah, and Saudi families who travel abroad in the summer holidays, are exposed to crowds, heat, shared food and variable water quality. Heat makes dehydration come quickly, and fasting can hide thirst. Carry ORS, drink bottled or treated water regularly, and seek medical help early. Seeing your doctor before the trip is especially helpful for older adults and people with diabetes, heart, kidney or bowel disease.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Should I carry a standby plan for travel diarrhoea, and what should it include?
- Which vaccines do I need for my destination?
- Do my regular medicines (acid reducers, diabetes or blood pressure tablets) need adjusting if I get diarrhoea?
- How long is too long to wait before getting tests after I return?
- Is it safe for me to fast during Ramadan while travelling?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide