Recreational Water Illnesses (RWIs) are infections caused by germs or chemicals found in water sources where people swim, play, or relax, including pools, hot tubs, lakes, and oceans. These illnesses are typically contracted by swallowing contaminated water, but they can also spread through contact, inhalation, or open wounds. RWIs present with a wide range of symptoms, making it important to understand proper home care, recognize when to seek medical help, and prevent further spread.
Identifying Common Recreational Water Illnesses
Most recreational water illnesses manifest as acute gastrointestinal issues, primarily involving watery diarrhea, stomach cramps, and nausea. The most common causes are the parasites Cryptosporidium and Giardia, which can survive for extended periods even in properly chlorinated pools. Symptoms typically appear between a few days and two weeks after exposure. While many gastrointestinal RWIs resolve on their own, some, like Giardiasis, can persist for two to six weeks or longer.
RWIs can also present as non-gastrointestinal symptoms. Skin infections, often called “hot tub rash” or folliculitis, are caused by bacteria like Pseudomonas and appear as a red, bumpy, itchy rash. Ear infections, commonly known as Swimmer’s Ear (otitis externa), result from water remaining in the ear canal, allowing bacteria to grow. Other symptoms associated with contaminated water exposure include respiratory issues, eye infections like conjunctivitis, and neurological issues.
Immediate Home Care and Symptom Management
The primary focus of home treatment for a diarrheal RWI is preventing and treating dehydration. Fluid loss from vomiting and diarrhea quickly depletes the body’s water and electrolyte stores. Oral rehydration solutions (ORS) are effective because they contain a balanced mix of sugar and salts, helping the body absorb fluids more efficiently than plain water.
Rest is an important component of recovery, allowing the immune system to fight the infection. For gastrointestinal symptoms, stick to a bland diet as tolerated. Avoid fatty, spicy, or high-sugar foods that can worsen diarrhea. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can manage fever, headache, or muscle aches.
Avoid using anti-diarrheal medications, such as loperamide, for many types of RWI. These medications slow down the gut, which prevents the body from flushing out the infectious organism. If the illness is caused by specific bacteria, like certain strains of E. coli, slowing the gut can increase the risk of serious complications. It is best to let the diarrhea run its course unless a doctor advises otherwise.
For skin rashes like folliculitis, immediate care involves showering with soap immediately after swimming and removing your swimsuit. Cool compresses and anti-itch creams, such as hydrocortisone, can soothe the irritation. Swimmer’s Ear may be alleviated by using over-the-counter ear drops designed to dry the ear canal.
When to Seek Professional Medical Intervention
While most recreational water illnesses resolve with supportive home care, certain warning signs indicate the need for professional medical intervention. Seek immediate medical attention if you show signs of severe dehydration, including lethargy, sunken eyes, a lack of tears when crying, or an inability to keep fluids down. High or persistent fever, especially one exceeding 102°F, also warrants a medical evaluation.
Other concerning symptoms include bloody diarrhea, severe abdominal pain, or diarrhea lasting longer than one week. Neurological symptoms, such as a severe headache, stiff neck, confusion, or seizures, are rare but require emergency care. Individuals in vulnerable populations—including infants, the elderly, and those with weakened immune systems—should consult a healthcare provider sooner, as they are at higher risk for severe illness.
A healthcare provider can perform diagnostic tests, such as a stool sample analysis, to identify the specific pathogen causing the illness. While most RWIs do not require specific treatment, this diagnosis is important because some bacterial or parasitic infections may necessitate a targeted prescription, such as antibiotics or anti-parasitic medications. In cases of severe dehydration, a doctor may administer intravenous (IV) fluids to restore fluid and electrolyte balance quickly.
Preventing Recurrence and Community Spread
Preventing the spread of an RWI is a public health responsibility that begins immediately upon noticing symptoms. The most important rule is to not swim when you have diarrhea, and to refrain from swimming for a full two weeks after symptoms have resolved. This extended waiting period is necessary because highly chlorine-resistant germs, such as Cryptosporidium, can be shed in the stool for days or weeks after diarrhea stops.
Practicing meticulous personal hygiene at home helps prevent the spread of germs to others. This includes thorough handwashing with soap and water after using the bathroom, changing diapers, and before preparing food. If caring for someone with a diarrheal RWI, take extra care to clean potentially contaminated surfaces, such as bathroom fixtures and changing tables.
To prevent recurrence, always shower with soap before and after swimming to rinse off germs. Avoid swallowing water while swimming in any recreational water body. Parents of young children should take them on frequent bathroom breaks and check diapers often. Change diapers away from the water’s edge to avoid contaminating the swimming area.