Picture this: You’re finally on that dream vacation, a paradise you’ve been planning for months. The sun is shining, the beaches are pristine, the palm trees beckon – at least, that's what you see from the window of your hotel, where you're holed up in the bathroom.

The reality of travel-related bowel issues is widespread, with the notorious traveler’s diarrhea affecting up to 70 percent of travelers.1 Constipation, bloating, and stomach pain can also ruin a vacation – or honeymoon.2

Individuals who travel to South Asia or low-income countries are at higher risk of getting traveler's diarrhea.2,3 But no five-star hotel in the world can completely protect you from the possibility that your trip will be derailed by gut issues.

That's why it's good to make gut health an integral part of your pre-travel plans, arming yourself with travel essentials and know-how before you take off.

Understanding why bowel habits change during travel

Up to 90 percent of cases of traveler's diarrhea are caused by bacteria from poor sanitation and/or food safety practices.1,2 Well-known bacteria strains like Salmonella and E. coli thrive on unwashed produce and foods that have been sitting out at room temperature (hello, pan-warmed street kebabs). One study found that 67 percent of international travelers picked up new strains of E. coli during travel.3

Viruses like norovirus can also spread more aggressively during trips that involve close quarters or sharing buffet-style food, such as on cruise ships or in hotels.1,2

Sickness while traveling can also result from a change in your normal routine. Some common disruptors include:1

  • Dehydration. Reduced water intake – or increased pina colada intake – can lead to dehydration, which causes constipation.
  • Changes in eating habits. Shifts in meal schedules and sampling new cuisines or local ingredients can lead to an upset stomach.
  • Poor sleep and jet lag. Red-eye flights don't just make you sleepy – they can disrupt the body's natural rhythms and affect your digestive system.
  • Stress. Quick layovers, lost luggage, language barriers – even the best vacations have their share of stressors, which can adversely impact bowel movements.

An unexpected travel souvenir: Altered gut microbiota

Seeing the world doesn't just leave its mark on your heart. New research suggests that vacationers often return home with an altered gut microbiome.

About one-third of international travelers pick up bacteria that are resistant to many antibiotics.3 These bacteria are brought home and shared with loved ones, facilitating global spread. International travel can also introduce new antibiotic-resistant genes in your gut, which can linger for months after your return home.3-5

The real kicker? Having diarrhea while traveling can make you more vulnerable to picking up antibiotic-resistant bacteria.4,6 So traveler's diarrhea is not just a hassle while you're exploring the world, but a likely predictor of problems after returning home.

Why antibiotics before your trip aren't the answer

In the past, doctors would often prescribe antibiotics before your trip to help prevent traveler's diarrhea. Now medical experts understand that travelers who take an antibiotic have a higher risk of getting drug-resistant bacteria and spreading them to others.1,4

Because the risk is generally greater than the benefit, your health-care team is unlikely to prescribe prophylactic antibiotics unless you have specific health conditions or are immunocompromised.1,2

Preventing and managing bowel troubles

There isn't a magic pill to prevent gut issues while traveling. But with careful planning and mindful travel practices, you can reduce the risk of having your digestive system ruin your vacation. Here's what medical experts recommend.

Before you go

  • Get a check-up. Your health-care professional can help you be your healthiest for a trip. This includes treating any existing condition that might worsen during travel, like irritable bowel syndrome (IBS). Ask if there are any vaccinations you need before you leave. 
  • Check for travel warnings. It’s always a good idea to check the Centers for Disease Control and Prevention’s website to find out if there are any current health risks at your destination. 
  • Pack essentials. Tuck a bottle of Pepto-Bismol in your suitcase. Some studies show that its main ingredient, bismuth subsalicylate (BSS), can cut your risk of traveler’s diarrhea by half.1,8 Although these studies recommend taking two chewable tablets four times a day for no more than three weeks, talk to your doctor to establish the best dosage for you.8 Toss a good probiotic supplement in your luggage too – starting a trip with a healthy microbiome can be protective against diarrhea and other abdominal symptoms.4,7
  • Plan for emergencies. Research how to access medical care at your destination should you need it – and whether your health insurance covers incidents that occur abroad.

While traveling

  • Stay hydrated. Drink plenty of safe fluids. Depending on where you travel, this usually means skipping tap water unless it's been boiled, like for tea.1,2,8 Be aware that some vendors might replace bottled water with tap water – so if you're unsure, then stick with sparkling water in cans or bottles with tamper-evident caps and packaging.9
  • Skip the street vendors. Keep in mind the old rule of thumb: "Boil it, cook it, peel it, or forget it." In other words, raw fruits and veggies, ice, undercooked meats, and unpasteurized dairy are off the menu.1,6
  • Practice good hygiene. Wash your hands frequently and thoroughly. Keep a small bottle of hand sanitizer with 60 percent or more alcohol for times when a sink and soap isn't handy.1
  • Don't overdo the medicine. Always follow the directions on a medicine's package. For example, Pepto-Bismol can bring relief, but it also can cause adverse symptoms and toxicity if overused.8 Also be aware that bismuth can cause your stool to turn black.
  • Get your steps in. Constipated? Movement gets things moving. Skip a taxi and walk when possible or take advantage of the hotel gym and pool.
  • Remember to breathe. Use mindfulness and breathing exercises to reduce travel-related stress. The security line at the airport is a great time for deep breaths.
  • Stick to healthy habits. Yes, a vacation is a time to relax, treat yourself, and try new things. But it's also important to maintain a balanced lifestyle by getting enough rest, being active, and eating nutritious foods.

After returning home

  • Monitor your health. If your bowel issues don't get better after coming home, then make an appointment to see your health-care professional. In some cases, an antibiotic can help treat lingering symptoms.1
  • Be patient. Most changes in gut microbiota will resolve within three months of returning home.5

Don't let the fear of bowel problems stop you from booking your dream trip. By following the above guidelines, you can minimize the risk of stomach issues and ensure that your vacation is both enjoyable and healthy. Stay informed, stay prepared, and most importantly, have fun.

A word from Thorne

If you’re planning a trip and you don’t already take a probiotic supplement to support a healthy gut,* then it’s best to start taking one several weeks prior to leaving on your trip. Try Thorne’s FloraSport 20B®, provided in individually wrapped blister packs to protect each capsule from high heat and humidity – and it’s in a box, not a bottle, so it’s great for tossing in your luggage.

Thorne's Melaton-3, a melatonin supplement, can help resynchronize altered circadian rhythms caused by jet lag.* Take it after you reach your destination about a half hour before you go to bed.

References

  1. Travelers’ diarrhea. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea. Accessed [June 12, 2024.]
  2. Butler D, McLoughlin R, Flaherty GT. Travel-related gastrointestinal diseases: Assessment and management. Public Health Challenges 2022;1(4).
  3. CJ Worby, S Sridhar, SE Turbett, et also. Gut microbiome perturbation, antibiotic resistance, and Escherichia coli strain dynamics associated with international travel: A metagenomic analysis. Lancet Microbe 2023;4(10):e790-e799. 
  4. Boolchandani M, Blake KS, Tilley DH, et al. Impact of international travel and diarrhea on gut microbiome and resistome dynamics. Nat Commun 2022;13(1):7485. 
  5. Shen C, Luo L, Zeng J, et al. Dynamics and persistence of antimicrobial resistance genes and gut microbiome after travel. Lancet Microbe 2024;5(4):e314.
  6. Furuya-Kanamori L, Stone J, Yakob L, et al. Risk factors for acquisition of multidrug-resistant Enterobacterales among international travellers: A synthesis of cumulative evidence. J Travel Med 2020;27(1):taz083.
  7. Alharbi BF, Alateek AA. Investigating the influence of probiotics in preventing Traveler's diarrhea: Meta-analysis based systematic review. Travel Med Infect Dis 2024;59:102703.
  8. Fan H, Liu IC, Gao L, et al. Bismuth subsalicylate, probiotics, rifaximin and vaccines for the prevention of travelers' diarrhea: A systematic review and network meta-analysis. Front Pharmacol 2024;15:1361501.
  9. Food and drink considerations when traveling. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/food-water-safety. [Accessed June 13, 2024.]