Traveler’s Diarrhea

Is it possible to talk about international travel and not speak of diarrhea?  Probably not.  Call it what you will—Delhi belly, Montezuma’s revenge, Tijuana Two-Step—a person’s chances of getting the ailment during foreign travel is almost two out of three.

The problem is that this illness becomes more of a threat during pregnancy.  Not only is it more apt to occur, it is likely to be more severe, the consequences are more dangerous and the treatment more difficult.

Your body’s main defenses against traveler’s diarrhea are your immune system, the acid in your stomach and the rapid transit through the intestine.  Antibodies and immune cells attack bacteria and viruses as soon as they enter your system.  And as soon as bacteria reach your stomach, the acidity eats away at their cell membranes and renders most of them harmless.  Those that escape are quickly hastened down the intestinal tract and out of your body.

All of these are affected when you are pregnant.  In order not to “reject” the baby (like a kidney transplant) the immune system is a little lax during pregnancy.  And even though you may not think so when you are overwhelmed with heartburn, your stomach produces less acid when you are pregnant.  Finally, as a side effect of the hormone progesterone, your intestines slow down.  Thus the germs that can cause diarrhea are not as efficiently killed or eliminated.

Further, because of other chemical changes that occur with pregnancy, diarrhea in a pregnant woman is more apt to lead rapidly to dehydration and acidosis.  And acidosis in a pregnant woman can kill the baby.

It is very important, therefore, that you do all you can to prevent the diarrhea and to treat it promptly and vigorously if it occurs.

Your first line of prevention is to wash your hands—after every handshake and before every meal.  This is a basic step that many travelers forget.  But this simple measure may reduce your chances of diarrhea by fifty per cent.  Soap and water are best but the alcohol-based cleansers are certainly better than nothing.

The second defense is to be very careful what you eat and drink.  While you are pregnant is not a good time to be an “adventuresome eater”.  Avoid the street vendors, the salad bars and the spicy foods.  Stick to fruit and vegetables that can be peeled and cooked food that is served steaming hot.  And use only bottled or boiled water, hot drinks like tea, or other bottled drinks—without ice.  Ice is often made with contaminated tap water.

If you do get diarrhea, the secret is prompt and vigorous oral hydration.  Try to drink twice as much fluid as you are putting out.  Oral hydration solutions can be bought commercially or made up from a recipe, but even a brisk intake of fluids that contain a lot of sugar and a little bit of salt will usually do the trick.  Remember that traveler’s diarrhea usually lasts forty-eight hours or less.  Your job is to keep up with the fluids until the problem wears itself out.

Medicines like loperamide (Imodium ADÒ) or diphenoxylate (LomotilÒ) are probably harmless when you are pregnant, but they slow down the exit of the germs from your intestine so we usually reserve these for severe cases.  We prefer not to use bismuth subsalicylate (Pepto-BismolÒ) during pregnancy.  Another salicylate (aspirin) has been shown in some studies to increase the risk of some pregnancy complications and bismuth, a heavy metal like arsenic, makes us nervous.

Antibiotics and intravenous fluids are usually best reserved for really severe cases.  Some of the antibiotics most commonly prescribed for traveler’s diarrhea are not of proven safety during pregnancy.  And in many area of the world the needles and tubing used for intravenous fluids may not have been properly sterilized.