How to Handle Traveler's Diarrhea in Southeast Asia

"Bali Belly" spells big trouble for every backpacker

Is this plate of fried frogs' legs REALLY safe for travelers?
Mike Aquino

Traveler's diarrhea (TD) may not be the most pleasant of subjects, but unfortunately it is a harsh reality for visitors to Southeast Asia. Unsafe food handling and exposure to new bacteria cause many travelers to develop the dreaded "Bali belly" within the first few days of their trip.

Not to worry: a case of traveler's diarrhea is certainly no reason to panic, or make drastic changes to your itinerary.

Getting to the Bottom of Travelers' Diarrhea

Just like most cases of stomach upset you get back home, TD is also caused by ingesting bacteria (usually bacterium from the E. Coli family) that your body hasn't had the chance to acquire immunity from yet.

We come into contact with bacteria every day – however, our bodies already have an immunity to many of the bacterias that we encounter at home. Changing continents means that we encounter new strands and must go through the process of building an immunity all over again.

Consider the local tap water: many locals drink straight out of the tap, but just a sip from the same source will ensure agony and watery stools in your immediate future.

It's safer to simply assume that tap water in many Southeast Asian countries is unsafe to drink. Drink only bottled water while you're traveling, that way you're sure the water has undergone extra filtration to get rid of those nasty bugs.

Malaria pills like Doxycycline contain strong antibiotics; over a prolonged period, antibiotics can destroy the "good" bacteria that lives in our intestines, reducing your immunity to bad bacteria. If you intend to take malaria pills while traveling, eat plenty of yogurt or consider bringing along L. acidophilus pills to take as a probiotic.

Can I avoid Traveler's Diarrhea by Not Eating Street Food?

Not necessarily; even safely prepared food in hotels and restaurants can cause traveler's diarrhea.

Although street food unfairly gets blamed for many cases of TD, avoiding it entirely is not going to eliminate your chances of getting traveler's diarrhea.

There's a reason why Penang's Lebuh Chulia, Makassar's outdoor grills, and Singapore's hawker centers keep 'em coming despite fears of Bali Belly: because of their quick turnover, newly cooked food never gets a chance to develop a bacterial load that sends you home with the runs.

Cheap, delicious street food is one of the many joys of traveling in Southeast Asia – don't let the fear of TD stop you from indulging!

Read about food in Southeast Asia, and about the street food scenes in Malaysia and in Indonesia.

How can You Avoid TD?

  • Look for volume: Stick to eating at popular places with a high turnover of customers. A high volume of business generally means that ingredients are fresher. Besides, word travels quickly; local customers would never return to an eatery if it made them sick.
  • Wash your hands: You can encounter diarrhea-causing bacteria just by touching surfaces. Many toilets in Southeast Asia do not have soap; carrying hand sanitizer is a good idea.
  • Use bottled water: Stick to drinking bottled water. Although many travelers use tap water to brush their teeth, remember that a single drop can carry a dizzying number of viruses.
  • Turn your phone into an anti-TD resource: a series of online tools from the CDC can offer up-to-the-minute advice on whether the food you're eating is safe.

These health tips for Bali travelers will certainly help you avert the disease that Bali travelers have (somewhat unjustly) named after the island.

What Should I Do if I Get Traveler's Diarrhea?

Getting TD isn't necessarily the end of your world – or even the end of your trip! Luckily, traveler's diarrhea is rarely a cause for serious concern; most cases heal naturally within a few days.

If you feel a stomach bug coming on, drink plenty of fluids. Diarrhea is a sure way to become dehydrated in Southeast Asia's warm climate. Consider adding electrolyte drink mixes to your water bottle to replace lost potassium and sodium.

If a case of TD persists for longer than a week or two, consider going to a clinic where you will probably be treated with antibiotics. Make use of your travel insurance – get to a doctor promptly if you pass blood or run a fever.

Should I Take Anti-Diarrhea Pills?

Although anti-diarrhea pills should be an essential part of any travel first aid kit, they should only be taken as a last resort.

Loperamide, commonly sold as Imodium, works by stopping the action of your bowels. While effective in the short term, this can trap harmful bacteria inside of your intestines which will only compound the problem later.

Only take anti-diarrhea pills when the situation demands (e.g., you are about to embark on a long bus or train journey).

What Are Natural Ways to Beat Traveler's Diarrhea?

  • Bananas: Do as the locals do; eat bananas to keep your stomach in check. Banana shakes and yogurt lassis are a great way to calm a bad stomach in tourist areas.
  • Yogurt: Probiotics are your friend; yogurt drinks can be purchased in mini marts. Check the label for active cultures, many are just sugary drinks.
  • Bland food: Although Southeast Asian food can be wonderfully spicy, lay off the laksa and chillies for a few days until things get back to normal. Stick to a starchy diet of plain, white rice and noodles.
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