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October 1997

Backcountry Diarrhea: Treating The Runs

When diarrhea strikes in the backcountry and there's no porcelain for 20 miles, the proper response can save your trip.


Whatever the causative agent, all diarrheal illnesses have one thing in common, and that’s the departure of fluid from the hindmost orifice, sometimes up to 25 liters in 24 hours in severe cases. And it’s not just water your body loses. An impressive amount of electrolytes (potassium and sodium) can be lost as well.

That’s why the single most important step in treating a diarrheal illness in the field is to replace lost water. Your best choices are clear liquids, including water, broth, herbal tea, and clearish fruit juice. If the illness continues and dehydration threatens, you’ll grow weaker, experience bouts of lightheadedness and dizziness, and require additional electrolytes. It’s a smart move to pack Oral Rehydration Salts in your first-aid kit, just in case. A good homemade tonic calls for 1 liter of water, 1 teaspoon of salt, and 8 teaspoons of sugar. Mix well. If you have baking soda, throw in a pinch, but you can get by without it. About one-third of the solution should be taken every hour along with all the plain water you can get down. Look for clear urine, the most reliable field sign of a well-hydrated person.

Pepto-Bismol not only relieves some of the discomfort, according to controlled studies, but also provides reasonable protection against traveler’s diarrhea. Imodium, a stronger over-the-counter drug, reduces the cramps and frequency and volume of stools. The prescription drug Lomotil ranks high among trekkers attempting to control the trots. A word of caution: Antidiarrheal drugs should not be used if you think you have dysentery. Severe diarrhea, bloody stools, high fever, and tenacious vomiting are indications that there’s something inside you that your body eagerly wants to get out. If you suspect that you have dysentery, let the diarrhea flow and find a physician.

When treating diarrhea in the field, stick with liquids until the problem subsides, then eat bland foods such as bread, crackers, cereal, rice, potatoes, lentils, pasta, or bananas. Avoid alcohol, caffeine, spices, fruits, hard cheeses, and other fat-laden products.

Perhaps the only good news about backcountry diarrhea is that it’s almost entirely preventable. Begin by disinfecting all wilderness drinking water through boiling, filtration, or halogenation. Boiling is the safest way, and water need only reach the boiling point to be rendered free of diarrhea-causing critters. Filtration is most effective when the device has been proven to remove protozoans and bacteria, as well as viruses. Halogens (iodine and chlorine) are the least effective because of the variable results based on such things as the concentration of the halogen, contact time with the germs, the clarity of the water, the temperature of the water, and the questionable efficacy of iodine and chlorine against Cryptosporidium.

Other keys to prevention involve proper food handling and camp hygiene. Be sure to carry foods that last a long time before spoiling. Also, eat everything in your pot. The bacteria that grow in leftovers will be killed by reheating the food, but the diarrhea-causing toxins produced by the bacteria are virtually unaffected by heat. Always wash your hands with soap and water after each bowel movement and before preparing food. Religiously wash and dry all community cook gear after use. Keep anyone who even thinks he has an illness out of the kitchen area. Don’t share personal items such as bandannas, cups, water bottles, and eating utensils. Properly dispose of human waste at least 100 yards from the nearest water source.

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