neurosurg

Diarhoea and all that

The two main types of “trots” that are prevalent when trekking are bacterial dysentery and amoebic dysentery. Food poisoning may also occur (I usually don’t eat meat when I am traveling in Nepal but maybe I’m paranoid!). You can also get Giardiasis due to infection with a protozoan called Giardia Lamblia but the incubation is about 7-10 days and often this responds to the same treatment as amoebic dysentry.

Prophylaxis: drink only bottled water and check the seal on the bottle before you drink. Don’t share water bottles with anyone not even your mother!!! Don’t take ice in your drinks and don’t eat any fruit that you haven’t peeled yourself. You also don’t know what salads have been washed in so stay clear of them too! Always wash you hands before eating preferably with a disinfectant soap (Dettol).

Diarrhoea is the body’s way of getting rid of toxins and bad bowel bacteria. If you have any gut problem of this type it is a good idea to rest the bowel by not eating any solids for about 12-24 hours and then start with maybe a bit of boiled rice or even just rice water and work your way up to more normal solids. Rice is binding and unlikely by itself to prolong the infection. Meat stays in the gut longer and infecting bacteria love it!

Usually there is a huge loss of salt and potassium in the diarrhoea so you need to replace this with some form of electrolyte solution which is readily available in chemists but certainly isn’t available up a mountain – so be prepared!!!!

Bacteria called Shigella cause bacterial dysentery and it is an acute illness with abdominal (tummy) cramps, fever, severe diarrhoea and accompanying dehydration. Diarrhoea is defined as an increase in frequency and a looseness in consistency, of the stool, not just one of the two.

Treatment: Ciprofloxacin (Ciprox) most would say one or two doses is enough but generally a three or four day course is OK.

Entamoeba Histolytica causes amoebic dysentery. It is not as acute as dysentery but diarrhoea, tummy cramps and horrendous flatulence is usual.

Treatment

Metronidazole for a week is the appropriate drug.

Food poisoning is when bacteria get into food and produce toxins into it. The toxins cause vomiting, diarrhoea and abdominal pain. You can avoid this by being careful to eat the right food prepared in a reasonably hygienic way by people you trust. Again it is more common in meat dishes than vegetarian food which may be why Hindus are vegetarians.

Like any gut problem the answer is to rest the gut by not eating for maybe 24 hours and to drink clear fluids whilst you are unwell. Taking a rehydrating preparation is useful if you are doing this but water is OK if you don’t have the stuff with you.