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delhi belly

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Your Health - Dr. Gita Mathai

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India is on the move, professionally and for recreation. Vacations for many no longer mean a visit to the grandparents and the native village. Tours, (in India and abroad), timeshares and exotic holidays are becoming common. The speed of air travel means that no corner of the globe is more than 24 hours away.

While travelling, the intestinal tract has to acclimatise itself with a shift in circadian rhythm (where there is a day night shift due to time differences) and the body clock has to reset. The normal viruses and bacteria present in food and water may be the same species as the ones at home but of different subtypes. The commonest ailment this causes is "traveller's diarrhoea".

In order for motion to be considered diarrhoea, it should be more frequent than normal (more than three times a day) and of a consistency less formed than usual. Diarrhoea may be accompanied by fever, vomiting and abdominal pain. There may be tenesmus - a desire to pass motion constantly even when the rectum is empty. If there is blood and mucous in the motion then it is more likely to be dysentery.

The commonest organism causing travellers diarrhoea is the bacteriaE.coli. The infection is usually acquired as a result of eating raw food (fruits and vegetables) or items which are not piping hot, drinking water or using ice cubes contaminated by bacteria. (Purchased bottled water sometimes may not really be as "pure" as advertised.)

The diarrhoea sets in 3-7 days after the initial exposure. There may be low-grade fever, but the usual symptoms are nausea, bloating, urgency and explosive diarrhoea. The disease is usually self-limiting and subsides on its own in another 3-4 days.

Giardia is another common parasite found all over the world. The symptoms are similar but take longer to set in. The discomfort progressively worsens. Eventually it may become a chronic diarrhoea which persists even after returning home.

Various viruses can also cause diarrhoea. Bacteria belonging to the salmonella or shigella group can also lead to diarrhoea though these infections produce fever and blood in the stool. Amoebae cause long-standing diarrhoea without fever but with tenesmus, abdominal pain, blood and mucous. Untreated, it can become chronic. It can also cause cysts in other organs like the liver.

Diarrhoea can often be treated without going to the hospital by replacing the fluid lost. ORS (oral rehydration solution) can be used as desired after it is reconstituted. In case ORS sachets are not available, homemade solutions of either half a teaspoon of salt and six level teaspoons of sugar dissolved in one litre of safe water, or lightly-salted rice gruel or even sips of plain water can be used. Bananas also help to reduce the frequency of stool. A tablespoon of home made curd on an empty stomach everyday will help to repopulate the intestines with "good" bacteria that fight infective agents. This works in the same way as the expensive sachets of probiotics with minimal expenditure.

Anti-motility agents like lomotil or imodium (lomofen) can reduce the frequency of stool. They do not have any effect on the organism causing the diarrhoea. They can cause bloating of the abdomen in adults. They are contraindicated in children under four years of age.

Diarrhoea needs to be taken seriously and a physician consulted if it persists for two weeks if the heart rate increases, a headache develops urine volume decreases, becomes dark coloured or is not passed at all confusion and disorientation occur there is fever blood is present there is documented weight loss.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in