What is Bali Belly?

Bali Belly, commonly known as traveller’s diarrhea, Montezuma's revenge, or the Rangoon Runs, is a frequent issue for people traveling from developed to developing countries. This illness can occur at any time during the trip or even after returning home.

Higher Risk Areas for Bali Belly

The risk of Bali Belly is higher in regions with poor sanitation and hygiene standards, such as the developing nations of Latin America, Africa, the Middle East, and Asia. It is more common in young adults than older adults, likely because younger people tend to choose more adventurous travel destinations or styles, like backpacking.

Symptoms of Bali Belly

Symptoms of Bali Belly typically start within 1 to 10 days after exposure and include:

• Abdominal bloating, cramps, and pain
• Diarrhea - loose and watery stools
• Vomiting
• Dizziness
• Sweating
• Lethargy
• Fever or high temperature

Causes of Bali Belly

Microorganisms that can cause Bali Belly include:

• Bacteria: Escherichia coli (E. coli), particularly enterotoxigenic strains (ETEC), is a common bacterial cause. Other bacterial causes include Campylobacter jejuni, Salmonella species, and Shigella species, often associated with severe abdominal pain and fever.
• Parasites: Parasitic infections such as Giardia intestinalis, Entamoeba histolytica, and Cryptosporidium parvum can cause diarrhea. These infections may last longer than a few days and result in bloody stools.
• Viruses: About one in three cases of Bali Belly is caused by viruses, particularly norovirus and rotavirus.
• Unknown Causes: In approximately one-fifth to half of all cases, a specific cause can't be identified. Diarrhea may be the gastrointestinal system's response to unfamiliar microorganisms.

High-Risk Foods for Bali Belly

Consuming contaminated food is a major cause. High-risk foods to avoid include:

• Raw and peeled fruits and vegetables
• Green leafy vegetables such as spinach and lettuce
• Raw, rare, or undercooked meats
• Seafood, especially raw or inadequately cooked shellfish or fish
• Sauces and mayonnaise
• Unpasteurized dairy products
• Food from street vendors
• Hot food left out long enough to cool
• Food buffets

Contaminated Water and Bali Belly

Water contaminated with infected faeces is another common cause. Tips to avoid contamination include:

• Avoid drinking or brushing your teeth with tap water if you are unsure of its safety.
• Drink bottled water, preferably carbonated.
• Boil tap water for at least five minutes before drinking.
• Avoid drinks containing ice.
• Do not use tap water to wash fruits and vegetables.

Preventing Bali Belly

Following steps are recommended by the CDC to prevent Bali Belly:

Good hand hygiene:

• Wash your hands with soap and water after using the toilet and before eating or preparing food.
• Ensure your hands are completely dry before touching food.
• Make sure dishes, cups, and utensils are completely dry after washing.
• Eat at reputable and clean restaurants.

Choose food and drink carefully:

• Consume only properly cooked food that is served hot.
• Wash raw fruits and vegetables in clean water or peel them.
• Avoid ice, as it may have been made from unclean water.
• If possible, drink bottled water or factory-sealed beverages only.

Preventing Bali Belly in Children

Children are more vulnerable to dehydration. To prevent infection:

• Prevent small children from crawling on floors.
• Make sure your child avoids putting unwashed fingers in their mouth.
• Encourage frequent hand washing.
• Use bottled water or boil tap water for at least five minutes when making formula milk.

Vaccination Against Bali Belly

Using the oral cholera vaccine has been shown to reduce the incidence of Bali Belly by half. It is often recommended by travel physicians due to its suppression of E. coli. It can be used in adults and children over the age of two.

Diagnosis of Bali Belly

Bali Belly is usually diagnosed by considering the person's medical history and conducting a physical examination. A stool sample may be required for testing if diarrhea persists, as different infectious agents respond to different medications.

Treatment for Bali Belly

The best defence is prevention. In most cases, Bali Belly is self-limiting and clears up in about four days. Treatment aims to ease symptoms and prevent dehydration:

• Drink plenty of water.
• Use oral rehydration drinks to replace lost salts and minerals.
• Over-the-counter drugs such as loperamide can be useful to decrease the frequency and urgency of bouts of diarrhea.
• Anti-nausea drugs can help with symptoms.
• Limit dairy foods as they can worsen diarrhea in some people.
• Avoid alcohol and spicy foods.
• Antibiotics may be prescribed for bacterial infections but are reserved for more severe cases and rarely necessary most of the time.

When Adults Should Seek Medical Attention

As per the Mayo Clinic, seek medical attention if you experience:

• Diarrhea lasting more than two days.
• Signs of dehydration.
• Severe stomach or rectal pain.
• Presence of bloody or black stools.
• Fever exceeding 102°F (39°C).

When traveling internationally, a local embassy or consulate can assist in finding a reputable medical professional who speaks your language.

Special Considerations for Children

Children are particularly vulnerable to severe dehydration from traveller’s diarrhea. Contact a doctor immediately if your child experiences:

• Persistent vomiting.
• A fever of 102°F (39°C) or higher.
• Bloody stools or severe diarrhea.
• Dry mouth or crying without tears.
• Unusual sleepiness, drowsiness, or unresponsiveness.
• Reduced urine output, including fewer wet diapers in infants.

Repeated Bouts of Bali Belly

Unfortunately, enduring one bout of Bali Belly doesn't offer protection against future bouts, as many different infectious agents can cause the illness.

Is Bali Belly Contagious?

Yes, Bali Belly can be contagious. Bacteria, viruses, and parasites that cause this condition can be transmitted from person to person, as well as through contaminated food and water. This underscores the importance of personal hygiene, particularly hand washing and avoiding touching your face when caring for someone who is ill.

Key Points to Remember

• Bali Belly is a common occurrence among international travelers.
• Symptoms include abdominal pain, cramps, and the urgent, frequent need to pass watery stools.
• The primary cause is consuming contaminated food or water.
• Bali Belly is usually self-limiting and clears up in a few days.
• It is contagious, and good hand hygiene is important to prevent transmission.

Post-Holiday Dilemma

As mentioned earlier, symptoms of Bali Belly can start after you have returned from your holiday. In such instances, it would be advisable to rest at home, which will also prevent spreading the germs at your workplace. If you need a medical certificate for your workplace, you can easily request a Medical Certificate Online in minutes from the comfort of your couch while you are recovering.

Disclaimer:

This medical blog provides general information and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with your regular doctor for specific medical concerns. The content is based on the knowledge available at the time of publication and may change. While we strive for accuracy, we make no warranties regarding completeness or reliability. Use the information at your own risk. Links to other websites are provided for convenience and do not imply endorsement. The views expressed are those of the authors and not necessarily representative of any institutions.