Avoiding dirty local water by not having ice or salad while travelling. Taking daily ‘friendly bacteria’ tablets to try and out compete the nasty ones to prevent Bali belly. Avoiding local food (badly cooked chicken, reheated rice, food with raw eggs & ice-cream)  and washing my hands before eating anything..

I’ve tried it all.

Nothing worked.

Pissing out of your bum is an occupational hazard on surf trips just like jet lag, sun burn and spending over budget.

It got to the point where on a trip to the Philippines I ate dog meat from a mobile street stall early on, hoping that the diarrhoea that followed would toughen me up and be the only ‘episode’ I had on the trip. Fail!

Theoretically ‘Bali belly’ (travellers diarrhoea) should be avoidable though. The steps I’ve tried do help reduce your chances, but you’ll end up having your fingers (and legs) crossed.

Having the squits is one of the most common causes of illnesses on a trip. It can be caused by simply a change in diet or bacteria (85% of diagnosed), viruses and parasites.

Most of the nasty bacteria are E-coli or its evil side-kick Campylobacter and their fury is limited to 2-3 days of diarrhoea. Hopefully

Infections lasting for longer are likely to be something a bit more exotic like Salmonella, Cholera or Shigella.

‘Shit tickets’
Don’t leave home without them.


Better out than in. Not thought to be the case anymore. The high poo output level was thought to be due to your body wanting to get rid of the nasty bugs, but its now widely considered to be because of the irritation to your gut.

You should aim to keep yourself hydrated.

Traveller’s diarrhoea in a warm climate can make you dangerously dehydrated. That means keeping yourself topped up with clean water (with hydration salts if you have them) and loperamide (Imodium) to block yourself up.

A lot of people find that they vomit with gut infections. If this is the case then have lots of sips of water. You’ll still absorb something hopefully. Take a tablet after a vomit and hope it stays down.


Most infections sort themselves out on their own. Just keep hydrated.

The World Health Organisation (WHO) advise a one off dose of Ciprofloxacin followed if this doesn’t work a day later by 500mg twice a day for 3 days.

This should help. If it doesn’t WHO advise to take Azithromycin 500mg once a day for three days. This is because a lot of bugs are starting to get resistant to Cipro.

Have a look at the article on which anti-biotics it may be wise to take with you. Remember that people can have nasty reactions to anti-biotics so be careful taking new ones.

It’s possible that your infection is a virus that may just sort itself out in time.

sewage fish food


Eat well and keep hydrated on a trip. You never know what’s round the corner!

The main problem is caused by dehydration. Getting fluids into you is a priority and if days keep going by and you can’t, then you need a hospital to stick some in your blood.

Losing lots of poo and vomit means that your body loses lots of important ions that it needs to function normally. You have a good reserve of them, but after a while without replacement (hydration salts) you will start to struggle and the acidity of your blood may start to change. This will then make you feel even worse than you initially did. This is a life threatening situation.

It’s hard when your life revolves purely around sleeping, puking and shitting, but try and make sensible decisions while you still can. No one wants public displays of infection (put nicely), but if you really start to struggle, get to a hospital. The shits can kill.

Don’t forget it could be hepatitis or a presentation of malaria!

If you start to get blood in your poo or vomit getting to a hospital is a good rule. If the blood is only on the toilet paper it’s okay usually. That’s if you even have any toilet paper. It may just be a dark hole and a bucket of water.


  • Take precautions.
  • Try and keep hydrated.
  • Take hydration salts (read instructions).
  • Take ways to clean water if you’re remote.
  • Take Imodium.
  • Take antibiotics with you.
  • Get to a hospital if you don’t get better and you feel gradually worse.

Remember that you’re not alone, and that one day in the future your life will once again not revolve around stomach cramps and explosive shit. Hopefully..

Author: Dr Dave Baglow

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There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.

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