Understanding Bali Belly
Bali Belly is a common term for traveler’s diarrhea, a gastrointestinal disturbance experienced by visitors to certain regions. It describes acute digestive upset characterized by symptoms like frequent, loose stools, abdominal cramps, nausea, and sometimes vomiting or fever. This condition typically arises from consuming food or water contaminated with various microorganisms.
The primary causes of Bali Belly are bacterial infections, though viruses and parasites can also be responsible. Common bacterial culprits include enterotoxigenic Escherichia coli (ETEC), Campylobacter, Salmonella, and Shigella. Viruses such as norovirus and rotavirus, and parasites like Giardia lamblia, are also known contributors.
How Bali Belly Spreads
Bali Belly can be contagious, primarily through the fecal-oral route, where microscopic traces of fecal matter from an infected person are ingested. This often occurs through contaminated food or water, such as when food handlers have not properly washed their hands after using the restroom, leading to contamination of prepared meals.
Indirect transmission is also possible through contact with contaminated surfaces. Pathogens can transfer from an infected person’s hands to objects like door handles, utensils, or shared bathroom facilities. Touching these contaminated surfaces and then touching one’s mouth can lead to ingestion of microorganisms. While direct person-to-person contact is less common than food or waterborne transmission, inadequate personal hygiene increases the risk of spread.
Preventing Transmission
Preventing the transmission of Bali Belly centers on rigorous hygiene practices and careful food and water choices. Consistent and thorough handwashing with soap and clean water is essential, particularly before eating and after using the bathroom. If soap and water are unavailable, an alcohol-based hand sanitizer with at least 60% alcohol can be used. Avoiding the sharing of utensils, drinks, or food with someone who is unwell also helps minimize risk.
For food and water safety, travelers should follow specific guidelines. Drink only bottled water with an intact seal or water that has been boiled. Avoid tap water, including ice, for drinking, brushing teeth, or washing produce. Prioritize thoroughly cooked and hot food, avoiding raw or undercooked meats, seafood, and unpasteurized dairy. Peel fruits yourself, and consume salads or raw vegetables only if washed with safe water.
Managing Symptoms
Should Bali Belly occur, the primary focus of symptom management is preventing dehydration. Drinking plenty of fluids, such as bottled water or oral rehydration solutions (ORS), is crucial to replace lost electrolytes and fluids. ORS packets are widely available and should be mixed with safe water according to instructions. Small, frequent sips of fluid are often better tolerated than large quantities.
Consuming bland, easily digestible foods like rice, bananas, or toast can help settle the stomach and provide some nutrition. Spicy, oily, or dairy-heavy foods should be avoided initially. Over-the-counter medications like loperamide can help reduce diarrhea symptoms, but use them cautiously and avoid if there is a high fever or bloody stools. Seek medical attention if symptoms worsen, including severe dehydration, high fever above 102°F (39°C), bloody or black stools, severe abdominal pain, persistent vomiting, or if symptoms last beyond a few days.