Diarrhea is by far the most common problem we encounter on any trek. Although it’s not inevitable that you will get diarrhea while you are away, it is pretty likely in some destinations. On an average, 1 out of 4 trekkers are affected by it. If not well handled, the same diarrhea might had been a nightmare for him, forcing him to retire from the trek itself. Here is few tips, how to avoid Diarrhea on Trek (what to do if it strikes).
Types of diarrhea
Different microorganisms cause different types of diarrheal illnesses, which may need to be treated in different ways. The most important things to look out for are: a high body temperature, blood in your faeces and how severe the diarrhea is (ie how often you have to go to the toilet).
Watery diarrhea:
This is the type of diarrhea you’re most likely to get when you are away. The cause varies with your destination, but it’s usually bacterial, often a strain of a bacteria called Escherichia coli.
The usual scenario is that the illness starts a few days after you arrive, and involves up to six episodes of loose faeces a day. If you get a fever with it, it’s usually low (less than 38°C). Nausea and vomiting are common, especially at the start, but it’s not a major feature of the illness (compare this with food poisoning). Stomach cramps, bloating and frequent gas are also common.
The illness generally resolves itself in a few days (on average three to five). It rarely causes severe dehydration, although the potential is always there and is more of a risk in children and older travelers. Don’t panic and start stuffing yourself with medications. The most important treatment measure is to avoid dehydration by replacing lost fluids and salts, which you should start doing straight away.
Bloody diarrhea (dysentery):
Dysentery is any diarrhea with blood in it. It can be more severe and protracted than the more common watery diarrhea described earlier, and usually needs antibiotic treatment.The most common cause is one of a number of bacteria, including various shigella and salmonella species.
Dysentery usually begins with nonspecific flu-like symptoms, and you often feel really rough, with headache, high fever (38°C and above), and aches and pains all over. To start with, the diarrhea is often watery and in large quantities; later it gets less and you start to notice blood and mucus (slime) mixed in your faeces. Painful stomach cramps are often a feature of the illness.
Get medical advice (or refer your medical chart you got prepared from your doctor) if you have dysentery, rest and make sure you drink plenty of fluids.
Vomiting & diarrhea:
If you suddenly get an attack of nausea and profuse vomiting soon after eating, it’s probably due to food poisoning.
Vomiting is the main symptom, often with stomach cramps and some watery diarrhea later. You may have a suspicion that you’ve eaten something that wasn’t fresh; another clue is if everyone who ate the same thing comes down with the same illness. Best way to avoid, take Vegetarian food.
No specific treatment is needed as a rule. You should rest, sip fluids if possible, and wait for it to settle down, which it should start doing in about 12 to 24 hours. Generally, it’s best to avoid anti-vomiting medication, as vomiting is your body’s way of getting rid of the bad stuff. You should seek medical help urgently if the illness doesn’t settle down within 24 hours.
What Causes Diarrhea On A Trek ?
- Use of stagnant/contaminated water.
- Eating by unwashed hand.
- Eating fruits without washing or peeling.
- Having excess of dairy products.
- Eating excessive dry fruits.
- Taking Diamox.
- Uncooked or stale meat/Non-Veg Food.
- Unhygienic Washroom Etiquettes.
Fact vs fiction
Not surprisingly, you’ll find diarrhea a hot topic of conversation among travelers, and it can be hard to separate fact from fiction at times. Just remember:
– Travelers diarrhea is generally a short, mild illness lasting on average about three to five days
– Replacing lost fluids and salts is the most important part of treating any watery diarrhea, whatever the cause
– There are certain situations when antibiotics need to be used – in these situations it’s best to get medical advice
Ways To Prevent It
Firstly thing to mention here is that your immunity system mater a lot in these kind of environment. Everyone has a different defense system towards the same water.
Secondly, never compare yourself with others, specially the local guides and porters as they are brought up using direct water from the stream and their immunity system is well developed against it.
Do not panic, and take proper prevention steps.
- Ensure toilet facility/camp is proper, enclosed and clean. Setup Toilet camp at a small distance from stay Camps, with proper washing facilities.
- Makes sure that the water you have is clean and free of any germs. While on a trek you have natural water from streams, always make sure that you use running water as the source of your drinking water. Do not use stagnated water.
- Treat your water. While the water in the cold is usually good and germ free, Its always recommended to treat your water. There are various ways to treat the water you are using. You can use UV filters, Iodine or chlorine dioxide solution etc.
- On a trek your hands are usually dirty which is unnoticed. Then in an energetic mood with group of friends, you usually forget to wash your hand before eating. Always remember to wash your hands before eating. Keep your hand sanitizer handy and remember to use it to clean your hand.
- Before eating fruits, make sure you are washing them.
- Reduce the intake of dry fruits, specially cashews and almonds.
- Refrain from having non-veg items on a trek firstly because it is difficult to digest it on high altitude, and secondly, if you are to have it anyways, make sure you have it fresh and treated. There are ways in which you can pack meat on a trek – You can pre-boil it and then coat it with salt and turmeric before beginning the trek. Make sure you consume it within 2-3 days into the trek. This keeps the meat free of bacteria in a cold weather. Ensure that you are cooking it full and bring to boil.
- If you are having diamox, have it post meals as having it before you meal has been found causing loose motion.
- Always follow neat and clean toilet etiquette while on trek. Make sure toilet facility/camp is proper, enclosed and clean. Travel Monk Adventures provides clean and enclosed toilet facility on all treks along with sanitary kit for safeguarding our clients against any such conditions.
- Remember that diarrhea is contagious so be scrupulous about washing your hands after you use the toilet.
*How to treat it if it hits you?
Even after taking precautions, there are chances that you are still affected by it. Do not start taking antibiotics immediately. At least wait for 3-4 flushes before you start on antibiotics. Antibiotics destroys bad bacteria, but also it destroys all the good bacteria.
Below are the ways to treat diarrhea during a trek
- Take ORS to replenish the salt and fluid loss.
- Continue to follow the precautionary steps as mentions above
- Have a full course of antibiotics –
Norfloxacin 400 mg twice a day for three days
Ciprofloxacin 500 mg twice a day for three days
Ofloxacin 400 mg twice a day for three days
- Its a good thing to take Tinidazole to protect against Protozoal infection as well.
Tinidazole 2 grams at bedtime for two nights ( Norflox TZ contains both )
Metronidazole 500 mg three times a day for seven days
*Anti-motility drugs(Stoppers)
These medicines do not treat the infection, but actually slows down the bowel movements, reducing the number of flushes. They are useful to treat cramping and should preferably be used with antibiotics to treat the actual infection.
Diphenoxylate (Lomotil®)
Loperamide (Immodium®)
Codeine and other narcotics
Again, depending on the time of onset and seriousness of the case, we need to decide if to go on Antibiotics + anti motility drugs, just antibiotics or just anti motility drugs.
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