Bali holidays are paradise but there is one thing that most travellers will try to avoid like the plague but it will catch up with them nonetheless. I am talking about the ominous Bali belly, which is a nasty form of traveller’s diarrhoea. (You can basically get it anywhere in the world.)
Not only can it knock you out for an entire week, make you feel weak for a few more but on top of it all, it can result in sickness and diarrhoea as well as actual fever. Not a nice outlook, is it? So here’s how to prevent it and – if you still get it – how to cope best with Bali belly.
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What are the Traveller’s Diarrhea Symptoms?
Imminent traveller’s diarrhoea you will be able to spot pretty quickly. Diarrhoea is usually defined as having watery stool at least three times during a 24 hour period.
The more severe the diarrhea gets, the more the urgency to race to the toilet instantly increases. You will nauseous, bloated and cramped. Here’s an overview of symptoms of Bali belly:
- Abdominal bloating, cramps and pain
- Nausea and/or vomiting
- Urgency/frequency in going to the toilet
- Mild temperature
- Feeling weak and uneasy
How long Does Bali Belly Last?
Usually, the symptoms clear up after 24 hours but with more severe traveller’s diarrhoea, it can take a few more days. Some Bali visitors complain about weakness and belly discomfort a week after as well.
This can also be due to weak immune system and the change in climate when coming or leaving Bali. Never overexert yourself! And always hydrate well (not with tap water, though).
The Difference between Bali Belly and Food Poisoning
Bali belly, traveller’s diarrhoea, and food poisoning are quite different things although they have shared symptoms.
While diarrhoea usually clears up after a day, food poisoning will hit you much harder. You will feel the first symptoms a few hours later already and then you are pretty much attached to the toilet for days.
On top of the diarrhoea, cramps and general weakness, you will also commonly experience nausea and vomiting. While this is happening you will also lose your appetite and maybe develop a mild fever and headache.
This also will naturally clear up after three days. (Again, medicinal coal and energy drinks help.)
When you start experiencing high fever, your diarrhoea doesn’t disappear, you get seriously dehydrated, you have bloody urine and/or you have trouble seeing or speaking, go see a doctor immediately!
Your travel insurance* should cover such emergencies. So even if you have to pay out of pocket first, you will get your money back later. It’s always advisable to call in before you go, if you can. Sometimes they recommend specific doctors.
While I was in the Australian outback and contracted either food poisoning or gasthroentritis, I was knocked out so much (basically unconscious for three days), I was critically dehydrated and the drip the local nurse put on me didn’t do anything for me.
This was a potentially disastrous episode of my travels I wouldn’t wish upon anyone. So don’t take this lightly.
What Causes Traveller’s Diarrhoea?
Generally, it had to do with your food and drink consumption. The perpetrators could be bacteria, parasites, viruses or a combination.
In a fifth of all cases, no specific reason is detected. Bacteria causing Bali belly could be e.coli, salmonella, shigella or campylobacter and usually cause a lot of cramps and abdominal pain.
With parasites, the symptoms lean more towards bloody stool and a longer time with diarrhoea and sickness. Viruses causing traveller’s diarrhoea are mostly norovirus and rotavirus.
- Unknown causes
What to Do for Travelers Diarrhea Prevention
Half of all travellers to Bali contract Bali belly, according to BIMC Hospital.
In short, everyone can get traveller’s diarrhea but if you are diabetic, immunosupressed, take H2 antagonist or antacids or have inflammatory bowel disease, your risk is much higher. So be extra careful.
Another factor working against you not contracting Bali belly are stress and jet lag. So especially after you land in Bali, adjust to the new climate slowly instead of throwing yourself right into the action.
Keep Restaurant Standards High
While you don’t have much influence on the cleanliness involved in food preparation and dinnerware hygiene, you can read up on reviews if you want to visit specific restaurants on Bali.
Next, have a quick look into the kitchen and check out the bathroom. If everything looks neat and there is enough soap, chances are that everything will be fine.
When you are not eating freshly prepared dishes in restaurants and cafes but instead at street vendors or from buffets, the risk of contracting Bali belly increases.
Always make sure your food is adequately hot and cooked throughout. Especially rice develops bacteria fast if it cools down or hasn’t been reheated enough.
Watch the Water
Another factor is tap water. While it is generally potable in Bali, most people do not drink it.
Ask your accommodation about the tap water quality. Some hotels will provide water bottles for the purposes of brushing your teeth etc even if they have a special filter installed in their taps.
If you don’t feel it’s safe to drink, don’t use it for your final dish rinse, on your toothbrush and don’t shower with your mouth open.
This also means avoiding raw foods, such as salads (which are quite popular in Bali too), as they are usually washed with tap water. Ice cubes with a hole in it are safe to drink as they were produced in a factory.
A no brainer but often shamefully overlooked is proper hygiene. This includes you – not just the person preparing food.
After going to the toilet and before preparing or touching food, wash your hands for 20 seconds with soap and dry them completely. Also let your dishes dry completely before using them. Remember, tap water might have been the culprit if you get Bali belly.
Get a Preventive Vaccine
To prevent sickness caused by enterotoxigenic E. coli (ETEC) bacteria, you could ask your doctor for a cholera vaccination.
This ingestible vaccine, the main brand is Dukoral, will place a very small dosis of dead cholera bacteria and nontoxic components of cholera toxin into your body, creating antibodies. You take two doses between one and six weeks apart.
This isn’t a cure all or ultimate prevention, however. But you may want to ask your doctor about it.
In Summary: How to avoid Bali Belly
- Avoid tap water contact – including brushing your teeth, eating raw foods and making ice cubes; or at least boil it
- Drink bottled water or carbonated drinks and make sure the seal is still intact
- Avoid certain types of food – raw fruits and veggies, raw/undercooked meats, seafood, (open) condiments, unpasteurized dairy, non-hot rice
- Practice good hygiene – wash your hands well for 20 seconds and dry them (as well as your dishes) before touching food, use sanitiser
What to Do For Diarrhea Treatment
In bad cases, you can get a fever and it will knock your system out like it did for me.
In that case, make resting for a few days your top priority and stay close to a toilet well stocked with toilet paper. Don’t go out unless you really have to.
Maybe someone else can hit the pharmacy for you? Sleeping and drinking as much as possible should be your priority in severe cases of Bali belly.
Get the Right Diarrhoea Medicine
The most widely available and easy traveller‘s diarrhea medicine is medicinal charcoal*. Ask your pharmacist for dosage, but generally you will take your pills three times daily for three days or until your stool ahs solidified.
The coal will line your stomach and keep harmful bacteria from getting too attached to you so you can discharge them more easily.
This is also why you should refrain from taking anti-diarrheal products that will clog you up (and keep the toxins, bacteria, parasites or viruses in), like Imodium*. If you are travelling and simply cannot trust your stomach or the toilet situation, immodium is a good idea.
If you feel like your severe diarrhea is getting out of hand, don’t wait to see a doctor.
Local doctors are great in that respect because they are much more familiar with potential local causes, such as parasites, than your doctor at home might be. Antibiotics are sometimes prescribed as diarrhea medicine but those should be a last resort from what I understand.
Adjust your Diet
When you have general diarrhea, you need to adjust your diet as well. Try plain rice, rice porridge, oats,, semolina custard, bananas, unsweetened applesauce or toast. Stick to super bland foods, avoid spices at all costs and drink a lot of liquids.
It’s best to drink clear liquids in the first 24 hours. This means, no juices or blends and especially no alcohol, caffeinated or carbonated drinks.
To help replace all the electrolytes you will undoubtedly lose to Bali belly, resort to isotonic sports drinks, such as Powerade* and Pocari Sweat*, and electrolyte replacement salts* and powder*, like Oralit. They really work wonders. (Just opt for the ones with the lowest sugar levels.)
Drink herbal teas, including chamomile and peppermint. Eat light food and stay away from fatty meals. Other things you can drink include fresh coconut, yokult and other probiotic drinks. But don’t forget to listen to your gut and see how you feel like. Take it slow.
Should You Be Super Afraid of Bali Belly?
Absolutely not. Traveller’s diarrhea, as the name suggests, can happen during your travels. Anywhere in the world. Anytime.
I’ve had it in Fort Lauderdale, Cape Town, Alice Springs and will probably get it again.
There is only so much you can do to prevent it. Wash your hands, santisise, stay away from tap water and prepare your own food with your own cleaned sets of kitchen utensils. But that’s not realistic on the road, is it?
Food poisoning isn’t life threatening and – as a precaution – you should travel with a medi kit including sets of medicinal charcoal* and painkillers anyway.
I also throw in a thermometer to check for fever and have emergency numbers of every country I travel to saved in my phone. Chances are you will not be in the middle of nowhere and not utterly alone. People are kind and will help others in need.
But with Bali belly, you will feel it coming and it will be fine after 1-3 days.
So enjoy your Bali travels as much as possible and rest if traveller’s diarrhea strikes you down after all so don’t miss out on too many days by dragging out the illness.
Now tell me: Have you ever suffered from traveller’s diarrhoea or Bali belly?
More travel tips for Bali
- How to avoid getting sick on the road
- When you lose your voice abroad
- How to sleep better during your travels
- How to combat allergies on your travels
- Tips for safety with tap water abroad
- What you must see in Nusa Penida