Bali Belly – Causes, Prevention & Treatment

Bali Belly is the common name given to an upset stomach or diarrhea that travellers sometimes experience during their stay in Indonesia. Whilst the name is unique, the condition of traveller’s belly or traveller’s diarrhea is certainly not restricted to Bali or Indonesia. In fact, it’s widespread across third world and developing nations where sanitation and hygiene standards are poor. Estimates put the number of sufferers somewhere around 10 million people each year or approximately 20-50% of all international travellers!

SYMPTOMS

Symptoms of Bali Belly include to varying degrees:

  • Nausea
  • Vomiting
  • Diarrhoea
  • Wind and bloating
  • Stomach cramps
  • Mild fever
  • General malaise

For some, Bali Belly can be a mild upset tummy that lasts for a few days before clearing up by itself. Whilst annoying, it doesn’t impact too much on their holiday. At the extreme end of the scale, a severe dose can be completely debilitating and last long after you’ve returned home. Needless to say, it can put a real dampener on an otherwise good holiday.

CAUSES & PREVENTION

Most cases of Bali Belly are caused through the consumption of food or water contaminated by bacteria, parasites, viruses or other unidentified contaminants. It sounds icky and it is, but the good news is you can significantly reduce your exposure and risk of contracting the illness by taking some simple precautions.

Avoid consumption of contaminated water:

  • Drink only bottled water – Most hotels and guesthouses provide two or more bottles of water a day in the room rate. Otherwise, bottled water can be purchased just about everywhere, even the smallest of villages and it’s usually very cheap with prices ranging from 10,000-50,000Rp (10-50 cents US). You should also use bottled water when cleaning your teeth.
  • Beware of ice – In Bali and more upmarket hotels and resorts, you can be pretty confident the ice in your drinks has been made using clean water. Elsewhere, consume at your own risk.
  • On the rare occasions that bottled water isn’t available, like say when you’re trekking, ensure that water is boiled for at least five minutes.

Avoid high risks foods, including:

  • Raw and peeled fruit. Fruit with skin that you peel yourself such as bananas, papaya, mango, rambutan, salak (snake fruit), jack fruit, pineapple, dragon fruit are generally fine to eat.
  • Leafy, green vegetables such as lettuce and spinach that may have been washed with unclean water.
  • Rare and uncooked meat or seafood of any kind.
  • Unpasteurised dairy foods, including milk and yoghurt.
  • Hot food that has been left out for any length of time. Many warungs in Indonesia pre-cook bulk food in the morning and leave it out for customers to serve themselves from throughout the day. You’ll often see bowls of food displayed behind glass windows. Avoid it like the plague. If you must eat there (in remote places you may not have too many choices), insist on fresh cooked food and stick with non-proteins such as rice and grilled corn.
  • Street food – I’m reluctant to say avoid street food altogether. We at RoamIndonesia are big fans of street food but you should use your common sense. Have a good look at the environment and the food before you purchase. A dirty cart, grimy looking vendor, flies, food left in the hot sun are all signals to avoid that particular vendor. Does the produce look fresh? What are the cooking methods? Food well-cooked over a sizzling grill or wok fried as you wait is considerably less risky than pre-cooked or uncooked food.

Exercise good hygiene:

  • Wash your hands thoroughly with soap and water or use an antiseptic hand gel after using the toilet and prior to eating or preparing food.
  • Ensure plates, cups and utensils are all clean and thoroughly dried before using.
  • Choose where you eat carefully. Avoid dirty or grimy looking warungs. One piece of advice we received from a local early on in our Indonesian adventures was to eat where the locals eat. Think about it – at home we avoid bad restaurants and dodgy take away venues. The locals anywhere are no different.