The Washington Post - USA (2022-05-08)

SUNDAY, MAY 8 , 2022. THE WASHINGTON POST EZ EE F5

BY TRISHA PASRICHA

It’s that time of year when
patients in my gastroenterology
clinic tell me about their exciting
summer plans — and the dreaded
scenarios that accompany them.
After a long hiatus from travel,
they can imagine finally sinking
their toes into the cool sand at the
ocean shoreline or trekking up a
picture-perfect trail to a gorgeous
view. But they can also imagine
their stomach suddenly gurgling
during these activities, giving
them the urgent signal that it’s
time to go, and with no bathroom
in sight.
Even the most regular person
can find their bowel habits
thrown off while traveling. And
when nature calls at an inoppor-
tune time (or perhaps fails to call
at all), it can leave vacation revel-
ers feeling down in the ... well,
dumps.
“Every one of us will experience
some level of altered bowel func-
tion when we travel,” said gut
motility expert Satish Rao, pro-
fessor of medicine at the Medical
College of Georgia at Augusta
University. “It’s extremely com-
mon, even though no one likes
talking about it.” He emphasized
that travelers should take proac-
tive steps to stay regular, rather
than waiting until something un-
comfortable happens.
Here’s why those unpleasant
changes in our guts happen and
how you can keep them from
ruining your next vacation.

Traveler’s diarrhea

During the height of the pan-
demic, concerns about classic
traveler’s diarrhea faded into the
background, because few people
were traveling anywhere. Now
that we’re traveling again, you
should be aware that 11.5 percent
of patients with covid-19 experi-
ence diarrhea, according to a
2020 systematic review of 43
studies, and a different 2020 sys-
tematic review found that up to
1 in 6 of such patients have only GI
symptoms. So, it’s always worth
having rapid antigen tests handy
on vacation.

But traveler’s diarrhea also

should be on our radar, advised

Ronald Blanton, chair of the De-

partment of Tropical Medicine at

Tulane University’s School of Pub-

lic Health and Tropical Medicine.

Up to half of travelers from high-

resource regions of the world de-

velop diarrhea, which is usually

caused by a bacteria such as E.

coli, according to a 2017 study

published by researchers from

Helsinki.

Today, few doctors would rec-

ommend taking antibiotics to

prevent diarrhea when traveling

because of the medications’ side

effects, the fact that most cases

resolve on their own (usually

within five days) and widespread

antibiotic resistance caused by

overuse. Regina LaRocque, an in-

fectious-diseases specialist at

Massachusetts General Hospital,

studied bacteria in the stool of

608 U.S. travelers who returned

from trips abroad and found that

people who had taken antibiotics

for traveler’s diarrhea were more

likely to have drug-resistant bac-

terial strains in their guts that

remained there even months af-

ter their trips.

Instead of antibiotics, Blanton

counsels people who want to be

proactive to try taking daily Pep-

to-Bismol, which contains bis-

muth subsalicylate and can be up

to 65 percent effective in prevent-

ing traveler’s diarrhea.

Generally speaking, well-

cooked foods are less likely to

transmit pathogens. (If you do

consume raw foods, choosing

items with a peel that you take off

yourself, such as bananas and

oranges, is safer.) Blanton also

encourages travelers to adjust the

times they dine according to local

customs. “If you go to have dinner

at 6 o’clock in Mexico City, that

food has probably been there

since noon, because people eat

[dinner] much later than that,” he

explained. “So food is prepared

freshly much later.”

As for drinks, although steam-

ing-hot coffee and tea are general-

ly okay, you should use only bot-

tled water that you open yourself

— even for brushing your teeth,

depending on your location. “It is

important to feel or see that the

seal on the bottle is broken in your

presence,” Blanton said. If not,

there may be a chance that the

bottle has been filled from the tap

or other sources.

But even if you follow all the

rules, you could still get sick. If

you do end up with traveler’s

diarrhea, staying aggressive

about hydration is critical. It’s

usually safe to take a medicine

such as Imodium to slow down

the frequency of stools — espe-

cially if you’re in a constrained

situation such as about to board a

flight — but anti-diarrheals

should be avoided if your stools

are bloody or if you have a high

fever. In that case, you should

immediately seek help locally.

Other concerning symptoms in-

clude being dehydrated, dizzy or

unable to keep any food down.

Another reason to seek out a

physician is if your symptoms

persist for more than two weeks,

whether at home or abroad. That

could be a sign of an atypical

infection (such as from a para-

site), depending on your activities

while traveling. Or, as I frequently

see in my clinic, it could be the

result of irritable bowel syn-

drome — a long-term disruption

to bowel habits sometimes trig-

gered by an infection — which

happens to almost a third of pa-

tients after experiencing infec-

tious diarrhea.

Traveler’s constipation

Although less well-publicized,

developing constipation while

traveling is about as common as

developing diarrhea (a 2003

study estimated that it affected

about 40 percent of international

travelers) and no less frustrating.

Unlike with an infectious etiolo-

gy, traveler’s constipation tends

to arise from disruptions to your

gut’s normal routine.

“Constipation is well-known to

happen among night-shift work-

ers, people like airline hosts and

hostesses, or nurses whose sched-

ules are constantly varying,” said

Rao, who studies the way daily

activities affect how the gut

moves. In the 1990s and 2000s, he

conducted experiments in

healthy volunteers examining

how the colon responded to eat-

ing, sleeping, exercising, and both

physical and psychological stress.

He and his team found that, at

night, the colon “sleeps” in a more

quiescent state, but as soon as we

wake up, it begins to buzz with a

threefold-higher rate of activity

that lasts about an hour and a

half. That’s why many people find

it easiest to have a bowel move-

ment first thing in the morning.

“Your colon has an intrinsic

rhythm and clock,” Rao said.

“When you travel, you can’t ex-

pect your colon to function nor-

mally, because that clock becomes

completely shattered.”

Plus, it’s often difficult to exer-

cise on vacation.

“Even if you’re relatively active,

if you’re sitting on a plane for

hours, you become almost com-

pletely immobile,” he said. “That’s

not helping your colon.”

Stress — a common feature of

many a family vacation — also can

have a big effect on how we poop.

Although psychological stress

can stimulate bowel movements

(if you’ve ever suddenly had to use

the restroom right before your

turn at karaoke, you know), most

people need a “safe,” clean and

preferably private commode to

feel comfortable pooping, Rao

said. That can be difficult to find

while traveling, which can lead to

constipation.

Some factors, however, are

more within travelers’ control. If

your vacation involves indulging

in low-fiber foods, which can ag-

gravate constipation, try consum-

ing more fruits and vegetables or

taking a daily fiber supplement to

keep things moving. To combat

dehydration, which can dry out

stools, I recommend that my pa-

tients drink plenty of fluids on

vacation. Lastly, because drinking

caffeinated coffee also increases

contractions in the colon, incor-

porating this into your morning

ritual might give you the boost

you need.

“I advise all my patients: Try to

stick to your routine as much as

possible,” Rao said. “Take a little

extra medicine with you if you

already have constipation at base-

line to try and cope with this.”

The bottom line (no pun

intended)

Traveling now, as it always has

been, is about weighing risks and

benefits. Indulging in local cui-

sine and escaping your usual hab-

its are great parts of vacation.

Knowing that your bowel habits

will probably change during your

trip, taking proactive steps to stay

regular and having a plan in place

if things deteriorate can keep the

focus on relaxing — and, hopeful-

ly, minimize the time you spend in

the bathroom.

Pasricha is a writer based in Boston.

Find her on Twitter: @TrishaPasricha.

How to prevent traveler’s diarrhea and other intestinal ills on vacation

ISTOCK/WASHINGTON POST ILLUSTRATION

it’s just beautiful,” says Carmon,
who learned about volunteering
during a camping visit. “And we
see deer every evening. Oh, it’s
just spectacular.”
Heather Burke, the national
partnership and volunteer pro-
gram manager with the U.S.
Army Corps of Engineers, says
volunteers are critical to the
agency’s sites in 43 states. They
help with interpretation and edu-
cation programs, fish and wildlife
habitat improvements, invasive
species management, trail con-
struction and maintenance, pho-
tography and more. “Last year,
we had more than 18,000 volun-
teers serving 1.56 million hours,”
Burke says. “And that equates to
about 750 full-time employees.”

Picking your park

As a volunteer at the light-
house keepers’ quarters at Cape
Lookout National Seashore in
North Carolina, Susan Burke, 74,
says the most common question
she gets is, “How did you get your
job?”
It’s actually a gig through
the National Park Service that
she found while perusing
volunteer.gov four years ago. For
two to three weeks a year, she
travels to the undeveloped bar-
rier islands and lives in a home
where lighthouse keepers lived
called the keepers’ quarters. By
day, she greets visitors who arrive
by ferry and boat and talks about
the history of the lighthouse and
lightkeepers. When the last pas-
senger ferry leaves, she embraces
the quiet. “It’s the best of both
worlds,” she says. “When the ferry
comes and the visitors come,
they’re all excited to be here, and
they’re having fun. And then they
all leave at 6 o’clock at night. And
I have the place to myself.”
The volunteer opportunities
available through the National
Park Service are as different as
the parks themselves, including
both run-of-the-mill duties (pick-
ing up trash) and intriguing en-
deavors (babysitting turtle nests
on a beach). Shari Orr, the nation-
al manager of the agency’s volun-
teer program, says nearly
300,000 volunteers a year play an
essential role. Because of the
pandemic, many regular volun-
teers have been unable to serve.
“A lot of parks are actually re-
building their volunteer pro-
grams right now,” Orr says.
“There’s a huge need for new
volunteers to come in or previous
volunteers to reengage.” Visit
nps.gov/getinvolved/volunteer or
volunteer.gov to see what’s avail-
able.

VOLUNTEERING FROM F4 From working the fields
to reef restoration
Imagine rising with the sun —
and roosters — to a farm-fresh
breakfast and spending your day
in nature, learning to milk cows
and tend crops. The nonprofit
Worldwide Opportunities on
Organic Farms (WWOOF)
(wwoofusa.org) connects the
farm-curious with agricultural
activities, including on urban
farms in Detroit or biodynamic
vineyards in Northern California.
Volunteers work about a half-day
approximately five days a week
alongside the host in exchange
for meals and accommodations,
which can include whimsical
treehouses or modest rooms in a
farmer’s home. Aside from an
annual WWOOF membership fee
($40 single, $65 joint), no money
is exchanged.
Most new members haven’t set
foot on a farm before, and they’re
often surprised but energized by
the experience, says Tori Fetrow,
outreach and marketing manager
with WWOOF. “I think people go
into it with their own idea of what
farm life might look like, but
when they get there, it’s a little bit
dirtier, it’s a little bit harder than
what they expected,” Fetrow says.
“But it’s really exciting, and you
find yourself doing these things
that you never expected to.”
The Nature Conservancy
(nature.org) is an environmental
conservation nonprofit founded
by volunteers, and it continues to
depend on them. “It’s really root-
ed in our DNA,” says Karen
Tharp, director of Nature Allies,
the conservancy’s volunteer and
community program.
Some of the outdoor opportu-
nities inspire intense wanderlust
— such as the chance to spend six
months conducting research and
helping out at a remote research
station at Palmyra Atoll in the
Pacific Ocean, about 1,000 miles
south of Hawaii. Or, on Virginia’s
Eastern Shore, near the town of
Wachapreague, building “oyster
castles,” which are structures
made of concrete where oysters
can live that help to protect the
land from storm damage and
waves.
Tharp says volunteering in na-
ture gives people a sense of satis-
faction and meaning. “We live in
a time where we’ve got climate
change looming, we’ve got envi-
ronmental justice issues brim-
ming, and people are just looking
for tangible ways to do some-
thing, to give back,” she says. “So
they feel like they can be part of
that solution.”

Silver is a writer based in Chicago.

Find her on Twitter: @K8Silver.

Add meaning to your adventure by volunteering outdoors

MARK SCHWENK

KEVIN WADE

TOP: Nature Conservancy volunteers build structures for oysters on Virginia’s Eastern Shore.

ABOVE: Donna Carmon’s Kansas visitor center role allows her to stay at a campground for free.

“A lot of parks

are actually

rebuilding their

volunteer

programs right

now. There’s a

huge need for

new volunteers

to come in

or previous

volunteers

to reengage.”

Shari Orr,

national manager of the

National Park Service’s

volunteer program