It can be impossible to avoid getting sick sometimes while travelling. But what do you do if you're still feeling under the weather after you've returned? Photo / Getty Images
It can be impossible to avoid getting sick sometimes while travelling. But what do you do if you're still feeling under the weather after you've returned? Photo / Getty Images
What should you do when you fall sick on holiday and you’re still feeling terrible once you arrive home? Sarah Pollok investigates
As I lay on the cold shower tiles, head centimetres from what had been my dinner just hours ago, I thought to myself, this is what you don’t see on Instagram.
The group trip around Morocco had, so far, been utterly perfect. But at 3.45am in a remote hotel in Ouirgane, a rural commune one hour south of Marrakech, I was horrifically sick. The kind of unwell that eliminates self-consciousness and makes you, no matter your age, desperate for your mum.
To spare the gruesome (and at one point, bloody) details, my stomach settled the following day and I labelled it food poisoning. Two weeks later, back at home, I was bedridden for two days with similar symptoms but waved it away as eating something that disagreed with my snowflake of a stomach. The third time it happened, one month after my trip, I wondered whether the first bout in Ouirgane was more than just a case of bad tagine.
One GP visit and three tests (blood, stool and urine) later proved the hunch correct. The tests revealed traces of Shigella, a bacterium found around the world and passed via contaminated food and water. Once in your system, it essentially inflames the heck out of your gut and wreaks havoc on your digestive system, which can take weeks, months or, in some cases, years to settle.
Since the bacterium was no longer active, antibiotics were off the table and I was told to simply give my gut some TLC and expect a few flare-ups.
It only takes one bad meal on holiday to make you sick. Photo / sour moha on Unsplash
Most of the time, when we experience gut troubles on holiday, we promptly recover and wave the illness off as food poisoning, traveller diarrhoea or plane constipation (yes, that’s a thing); illnesses that come, give us a bit of a smack then eventually go.
Consequentially, the internet provides endless tips, tricks and advice for avoiding or treating these issues while travelling. Yet, as I discovered, there is far less information on what travellers should do when their trip ends but the symptoms don’t.
According to gastroenterologist Richard Gearry, who heads the University of Otago’s Department of Medicine, the first thing people should do is visit a GP to identify, via a stool sample, whether they have picked up something overseas.
“Most infections with bacteria viruses are self-limiting but parasitic infections, in particular, can be ongoing so having an examination of faecal samples for those is quite important,” Gearry says, as this can dictate the best course of treatment.
What tests should I request?
Your GP is typically best equipped to know what questions to ask or tests to order. However, there is certain information the practitioner should ask and tests worth considering, according to travel clinic WorldWise.
Aside from medical history (which can influence someone’s risk profile), an assessment after travel sickness should discuss previous vaccinations and various details about the trip itself, such as the destination, activities, accommodation, what you ate or drank, whether you had close contact with animals and whether you sustained any injures, scratches or bug bites.
As for tests, the clinic says it’s wise to test blood counts, faeces (for ova and parasites), urine and possible additional blood tests for less usual diseases related to certain destinations.
Understanding ‘flare-ups’
In many cases, such as my own, a faecal test ordered by my GP may identify a bug but show it’s no longer active. Yet I continued to experience flare-ups; bouts of similar symptoms to my first episode.
Here, Gearry says, it’s important to understand some bugs can continue to cause issues long term.
“For any gastrointestinal disease or gastrointestinal infection, about one in six people will get ongoing symptoms after the infection is cleared, even though there’s no ongoing evidence that the bug is still present in their body.”
This is called post-infectious IBS, Gearry explains, and global studies have consistently found one-sixth of people who catch gastrointestinal infections experience ongoing symptoms.
Symptoms of post-infectious IBS tend to mirror the symptoms one experienced during a first bout of sickness.
“Typically, these would be similar to the symptoms they had when they had the illness, so diarrhoea, abdominal, pain, bloating, et cetera.”
If symptoms continue, it’s important to get a second check-up to rule out any nastier illnesses with IBS-like symptoms, such as bowel cancer, inflammatory bowel disease (IBD) or Crohn’s.
This is less likely but still worth checking for, according to Gearry. People usually begin this process in a GP’s office and are referred to a gastroenterologist when necessary.
“It’s going to go through general practice to start with, and then general practice refers to gastroenterologists for opinions and investigations based on the history of what happened, but also the past history of other stuff going on in family history and things like that,” he says.
Treating post-infectious IBS
If gnarly conditions are ruled out, it’s likely post-infectious IBS. While there is no cure or pill, you can treat it as you would typical IBS.
Given my gut had taken a beating, I thought (from extensive Google searches and social media wellness influencers) that prebiotics and probiotics were the first port of call to heal and bolster my gut microbiome. However, the experts were sceptical.
Brands that sell probiotics claim they provide health benefits when consumed, typically by improving or restoring gut microbiota. Photo / 123rf
Using supplements to replenish or boost your microbiome may feel like sense but Gearry says the scientific literature is limited. This doesn’t prove they don’t work but rather that studies are expensive and difficult.
Since there is little harm in taking pre/probiotics for gut troubles, Gearry says people are welcome to try them if no other treatments help but they should approach it intentionally.
This means being clear about the symptoms you want to improve, taking supplements consistently and observing whether symptoms improve and whether they return when you stop.
An approach with more robust evidence is the Low Fodmap Diet, a temporary diet found to improve symptoms for 75 per cent of people, according to Te Whatu Ora Health New Zealand.
Other solutions include reducing caffeinated drinks and rich food or taking certain medications to target specific symptoms, such as laxatives, smooth muscle relaxants or antidiarrhoeal medications.
