BALI BELLY - and other health issues in Bali.

 

 

Many travellers get an upset stomach, and not just in Bali either.

This is usually due to a change in diet and activities and will quickly fix itself if you moderate the changes you have made. In Bali the most common change is to be a bit piggy over all of the new, exotic and fabulous fruit that you will find there.

 

DO NOT CONFUSE THIS SIMPLE AILMENT WITH BALI BELLY!

 

You will know when you have Bali Belly - you feel like nothing you've ever been like before, both ends are running, often at the same time, and the smell will be so vile that you would prefer not to be in your own company but you can't just get up and leave!

 

Bali Belly is a pain in the - - - -, for at least 24 hours and certainly for days if not quickly and effectively treated.

 

PREVENTION -

There are many recommended remedies but its best not to get it in the first place. Personal hygiene needs to be watched more carefully than at home, particularly hand washing. You’ll know that you’ve got it about 3-4 hours after you get it – the bug that is. You might not want to believe it at first but a couple of hours later there’ll be no denying it.

 

If you get it have the hotel call their doctor for you. You will get a shot in the backside and several tablets to take and you'll be able to safely get about in 24 hours. Any other course of action - or no action at all - is just plain foolish and will not only ruin your holidays but also that of your family and friends. Is that what you came to Bali for ? ? ?


DO NOT DRINK THE WATER FROM THE TAPS!

Be especially careful of this when your guard is down – in your hotel shower and when cleaning your teeth. Keep bottled water in your bathroom at all times. Purchase your own if you are in a cheaper hotel that does not supply it. You must however drink adequate water or you will dangerously dehydrate in the tropical climate. Safe, bottled water is cheap and readily available virtually all over the island. You know you’re on a good thing when you see the locals doing it!  Guys (and Gals?) if you use a blade razor to shave do not rinse it under the tap. Rinse it in bottled water also or you might break out in a rash that is not nice in sensitive areas.
Wash your hands after visiting the toilet or handling money particularly. See ‘HEALTH PROTECTION’ below.
Don’t drink using straws as they are washed and re-used in some places.
Don’t buy bottled drinks that are kept cool in ice/water slurry in cold chests. Purchase only from refrigerated cabinets.
Ice in the tourist areas is made under government control and should be safe in drinks.

 

The time from infection to symptoms varies from a day to 2 weeks and the problem is contagious throughout the period that the organism exists in the gut and is being passed. Warning to Mum's and Dad's - Take care not to catch it from the kids (or a partner). For the full details go to http://www.aafp.org/afp/990700ap/119.html.
 

Imodium is a common clinical remedy (A$2.00 app; take 2 tablets straight away and 1 next morning).
Some say this is only a ‘stop gap’ (is that a good choice of words?) for situations where you must travel as it can interfere with the bodily functions and inhibit the flushing out the bacteria and toxins. These antagonists would say that Pepto-bismol is a better way to go. 8 tablets a day, every day, all at once or spread out thro’ the day. Changes the acidity of your gut and drives the bugs out so they don’t multiply faster than your system can handle them.
Loperomide usually works within 1 hour. Others recommend daily Acidophilous tablets as a preventative to ward off the bugs.
Cipro or Ciproxin is a common prescription cure-all anti biotic.
Another remedy is Norritt, little black activated charcoal tablets available at Matahari Supermarkets and many other places in Bali, including many Circle K stores and Mini Marts, for Rp6700 for 40 tablets. 6 to 9 tablets three times a day.
Some travellers swear by lots of Entrostop charcoal tablets from a local ‘Apotic’ (chemist or drugstore). They should not be used with other medication – or at least not within 4 hours as the beneficial effects of both may be cancelled out.
Locals reputedly use SG Tablets from their local ‘Apotic’ (chemist). They are not easy to find and you may be told that they are no longer made. Keep searching.


A recently recommended preventative with solid (no pun intended) support is Raspberry juice – with at least 30%, preferably more, real juice in the blend. Mix it strong – 25% cordial: 75% bottled water. Ellagic acid is the ingredient that makes the difference! Some people have a neat swig every morning before breakfast, about 10 mil of 100% strength, 20 mil for 50% etc. Good for kids.
In Oz, some Coles Supermarkets stock Sunraysia Premium Raspberry Delight – 80% - A$7.99 for 375 ml. It is a warehouse item and can be ordered in by any Coles manager. Also available from many supermarkets in Bali, including Circle K shops.
100% natural Garden Fresh raspberry fruit syrup is available at the Pasadena Foodland in South Oz, A$5.50 for 750 ml bottle, also Golden Grove Village. Other Foodland managers can get stock in for you with a little persuasion. Contains only sugar, raspberry juice and citric acid. Used for drink flavouring and dessert toppings.
Also raspberry syrup available at Gaganis Bros just off South Road at the intersection with Grange Road. 1.5 litres for A$4.95.
Also in South Oz (and maybe other parts of Oz or the world) - Kevron Aust, 188 Glynburn Rd Tranmere Ph 8332 6055 or fax 8364 0739 , E-mail
kevin@kevronfoods.com.au. Also - Aust Food Innovators, PO Box 970 Berri SA 5343 Ph 8582 4233 Fax 8582 4344, E-mail sales@austfoodinnovators.com.au.  Pure raspberry juice with no artificial flavours, sugars or preservatives, 100% natural.
Marsaka brand Raspberry Juice has a 65% concentration of juice. Available in Continental delis, even some butchers and supermarkets. In a 1 litre glass bottle so best to decant into plastic drink bottles for the trip over. The importers are Marco Polo Foods in Campsie, NSW. Ph 02 9718 8922 to find out your nearest stockists. In Adelaide the distributors number is 8345 3792 for your nearest stockist.
In '05 the Coles Supermarket at the Colonnades Shopping Centre had Fresh Attitude 100% Raspberry Crush (in the fruit and veg section) - 300ml bottles for $4.98
Anchor Cordial is available from Dawson's and Supa Valu in the northern Perth suburbs. Check the concentration of raspberry.
Cascade Raspberry Fruit Juice Syrup is also good. Ph Freecall 1800 641 647 for stockists in your (Oz) area.
Dick Smith and Golden Circle (in Oz) both have raspberry cordial with 40% juice. 
Coles (at Warwick in WA and Colonnades in Sa at least) had 100% Natural Raspberry Crush made by Fresh Attitudes in '05. $4.50 for 300ml. $4.95 in SA. No added sugar no preservatives, no concentrates. Check the expiry date and refrigerate after opening. Can be frozen.
Get the good oil from this web address: :-
 
http://www.abc.net.au/worldtoday/s263898.htm .
100% concentrate is available from Bramble Farm in Langwarrin, Victoria, Australia from Di Benson who will post you a supply COD – Di Benson at
brambleb@bigpond.com. Ph 03 9776 7018. Take 10 mils undiluted twice a day. Tastes good, berry flavour, not sickly sweet.
Also from Shepparton at
http://www.berrysweet.com.au/.

In '07 I heard that it was now available at the Gourmet Garage in Jimbaran Bay. This will save some weight in your bags going over to Bali.


Some travellers also recommend a daily ’Yakult’ yoghurt drink.  Similar anti-bacterial agents are available in tablet forms.  One is Megadophalus from health food store or chemist.  Start taking a daily dose up to a month before you leave.
If you want to go the natural way be prepared to start up to 3 months before you leave as the body is slow to adapt to a new regime and develop the required resistances to invading bugs.
Another natural way to ward off the bug is Acidophilus Capsules from Health Food stores. Somewhat similar to Yakult. Best to start well before you go.

 

Medical recommendations -

In early '07 a qualified nurse had this to say on a public forum (my emphases):-

Most people confuse traveller's diarrhoea with Bali Belly, but they are actually different.

Traveller's diarrhoea occurs with a sudden change in diet - spicy foods, tropical fruits, etc. & usually the body gets used to the changes and soon adapts and your bowel actions will normalise. It's characterized by sudden abdominal cramping & urgent explosive bowel motions. It is fine to use Imodium or Kaomagma to treat this. You should make sure you drink plenty of water to avoid dehydration remembering that you are in the tropics.

Bali Belly is more akin an acute case of gastroenteritis which can be caused by either a bacterial or parasitic infection. It is passed on by the faecal-oral route so good hygiene is vital. It is characterized by abdominal pain which usually comes in waves, by nausea, by vomiting & by diarrhoea. More often than not the victim is bed ridden, feeling too ill to move about and wants to be close to a toilet.

In this instance, it is best to call a doctor, who will likely give you an antiemetic injection like Maxolon or Stemetil to help stop the vomiting & an antibiotic to kill the bug/bacteria.

Treating the Vomiting:
The gut needs to be rested, so do not eat or drink anything for 2 hours, (you can sip enough to keep your mouth moist, but avoid swallowing anything).
Slowly introduce swallowing a few sips of water every 10 minutes or so over the next 2 hours (in small children - a teaspoon of water every 10 minutes). If this is tolerated after 2 hours, you can commence larger drinks & consider replenishing the electrolytes lost with gastrolyte (paedalyte for kids) or similar. Icy poles are a good source of fluids for fussy children. Avoid fruit juices, as they are too acidic & will upset the stomach further. If a child will only drink juice, dilute it as you would cordial.

Do not drink alcohol, as it will dehydrate you further.
If drinks are tolerated over the next 2 hours, you can add bland carbohydrates into your diet - such as dry crackers, rice (easy to get in Bali), potato, white bread, porridge, etc. Do not recommence a normal diet until 24 hours has passed since you last vomited and avoid diary products for another day or so. If vomiting re-occurs go back and recommence the regime from 'sips every 10 minutes'.

If you are unable to hold anything down for 6 hours, call the doctor again - it's time for another antiemetic injection.

Signs of Dehydration:
Mild to slight - decrease in urine output, urine concentrated & sinks to bottom of toilet bowl.
Moderate - dry tongue & lips, no urine output for 8 hours in young children, 12 hours in older children & adults, mild irritability, sunken fontanelle in babies.
Severe - no urine output, tongue sticks to roof of mouth, sunken eyes, sunken fontanelle in babies, no tears when crying, irritable, confused.
Severe dehydration can lead to shock, especially in children so be vigilant looking for signs.

If you or your child shows signs of moderate to severe dehydration, it's time to quickly get yourself or your child off to hospital for medical intervention & IV re-hydration.

Contrary to some advice in recent posts, it is OK to take Imodium when you have Bali Belly, so long as you do not exceed the recommended dosage & keep up your fluid intake. Imodium is widely used in hospitals to treat acute diarrhoea.
It is a MYTH that you need let the diarrhoea run its course - the bugs are not flushed out in your bowel motions, though they may be present in it. It is more important to slow the diarrhoea to avoid dehydration.
Once the diarrhoea has settled & you’ve had no bowel motions for a couple of days, you can treat it with an increase in your fruit & fibre intake. You can consider aperients such as coloxyl, nulax, etc. but take it easy with the dosage. Less is best.

Naturally, if the symptoms persist, seek medical advice or go to hospital.

 

The Bali International Medical Clinic (BIMC) has dietary recommendations if you’re unlucky (or careless) enough to get it.
AVOID – greasy fried foods, soft drinks, alcohol, coffee, dairy foods except plain natural yoghurt, spicy foods, excessive smoking and any food or drink that is either very hot or very cold.
RECOMMENDED – Isotonic sports drinks such as Gatorade, pocari, sweat etc, apples, bananas, plain rice or porridge, oats and semolina custard, clear soups, herbal teas, natural yoghurt and acidophilus/ biphodophilis supplements, ginger and peppermint oils in lollies or teas, small quantities of fluids regularly. Babies and young children may become temporarily intolerant to cows milk but should be able to handle soy milk.


It is always best to discuss these things with your doctor before you go of course (and if you are travelling with children be sure about child-size doses too), but if you get ‘caught short’ then try something that has provided relief or protection to others rather than do nothing.
If you get it (the dreaded ‘BB’ that is), drinking lots of water, light teas, perhaps a little boiled rice will do no harm. Most would agree that if you are feverish and vomiting with stomach cramps and the squirts get a doctor and have a shot in the bum, and no arguments. (You do have travel insurance – don’t you!) If you vomit after having prescribed tablets cut them in half and take the lighter dose twice as often.

See also ‘Eating’ and ‘Drinking in Safety’ in the 'Forum Recommendation' section at www.filosbali.net.


Don’t confuse the body’s normal reaction to a sudden change of diet, especially a diet with heaps of fresh fruit in it, with Bali Belly.  Change your diet slowly, working from your normal foods to more exotic ones in easy stages and small doses. Within a few days you will be safely ready for anything that exotic Bali can provide for you – except the reticulated water!


Whilst it is prudent to be cautious and use common (or un-common) sense do not let senseless paranoia ruin your holiday.

 

Carry toilet paper with you everywhere in Bali even if you don’t have Bali Belly. The chance of you finding a good, clean, comfortable, useable, flush toilet when you’re out-and-about in Bali is slim. The chances of you finding good, clean, comfortable, useable toilet paper in public places away from your hotel, even in reasonable restaurants, is almost zero! You might like to look at ‘Toilets, Loos and Dunnies’, in the 'Forum Recommendations' page of www.filosbali.net.

 

HEALTH PROTECTION.
Be wary but not paranoid to the point where you ruin your holiday. The vast majority of travellers never catch anything, but most are prepared and take simple precautions whilst on holiday.
You should consult with your medical advisor about your possible need for the following shots before visiting some parts of Bali, Lombok and other Indonesian islands:
Have a look at the Q & A section of the Better Health website to find some valuable facts rather than listen to helpful but probably ill-informed friends.
** Diphtheria/tetanus – up-dating with booster shots strongly advised, even if you’re not going to travel.
**  Polio. A good idea to be current with your protection anywhere in the world – even at home.
** Hepatitis A. Many doctors will advise it. A follow-up shot after 6 months will give you the best lifetime protection that’s available at the moment. Don’t forget it if you intend to travel in the future.
**  Hepatitis B. Do you live a bit on the wild side? – take a few risks? – Then certainly get this shot.
** Typhoid. Particularly advised for some areas. In early '05 it was revealed that a doctor had diagnosed and reported typhus in Singaraja.
**  Malaria is particular risk in Lombok and other islands and only somewhat less so in Bali. 
You should be a bit concerned that malaria is reportedly on the rise in Bali despite conflicting claims that the island is malaria free. In the southern tourist areas alone there were 688 cases reported within the first quarter of 2002. The whole of 2001 for this area saw only 753 cases with 8 deaths. Protection is wise. Dress to cover legs and arms from sundown on. Use skin repellents liberally and ask for a mozzie coil to be placed under your table when dining.
** Dengue Fever is another mosquito borne disease which can sneak up on you anywhere in the tropics. The mozzie is smaller, quieter, less painful and active during the day, which of course increases the risk of being bitten. It pays to use repellent all the time. If you suddenly develop a fever with a rash, call a doctor. Some travellers suggest that vitamin B1, started 2 weeks before you go and continued while you are there makes the skin unattractive to the Dengue mosquito.
- If your travels are going to take you further north the risk situation would be worse. 


4 to 6 weeks before travel consult your doctor for CURRENT medical advice and preventative medicines (be very careful in maintaining the dose schedule) rather than relying on out-of-date travel books or past freedom from infection. 


- Precautions are simple to take. Doryx is a commonly prescribed anti-malarial.
- Anti typhoid might also be wise.
Have a look at
http://www.cdc.gov/travel/seasia.htm.


DO CONSULT YOUR DOCTOR FOR CURRENT ADVICE.


When in Bali wear clothes that cover bare skin around the hours of sundown - when mozzies are particularly active – to dawn. Use personal repellents and aerosol sprays. Ask for a mozzie coil to be lit under your restaurant table. Mozzie nets might be advisable for sleeping in northern areas where there might be no window screens. Some travellers even dip them in insecticide. They are not all that common in the shops in Bali but there is a shop in the small street that runs between Jls Melasti and Padma. Also further along Jl Legian towards Seminyak there are some other shops. Another shop is in Jl Sahadewa (also known as Garlic Lane) towards the end nearest Melasti Street where the Taman Legian Gardens Restaurant is on the corner. Shops which sell cushions also seem to have them frequently.
The Oz Army uses Johnsons Baby Clear Lotion Anti Mosquito (with a light green cap in 2002) in tropical jungle work. Has no DEET so good for those with sensitivities. - - - “ . . it worked for us too!”.
Aquaear for tropical fungus ear infection prevention.
Dermasoft and/or Dermaclean Lotion, disinfectant, instant dry for hands or a waterless antibacterial hand wash, available in the Matahari supermarket in Kuta. Has moisturiser and is self-drying. 100 ml tube. Use it before eating especially if you’ve been handling money – which you will ALWAYS be doing, I guarantee!
Aqium Gel. Waterless hand wash. Not sticky. 70 & 375 ml containers. $3.95 and $6.95 from pharmacies in Oz. Pump pack and purse pack. Cheaper than hand wipes and nothing to throw away afterwards.
Wet Ones Anti-bacterial Wipes. Check supermarkets for Johnsons in baby section. Also Dettol Wipes which are in a green and white pack and a bit stronger than baby wipes perhaps.
Antis, a waterless hand gel, is available from some supermarkets in Bali.

 

If you’re travelling with kids take (or purchase there) a half litre, trigger operated, plastic spray bottle and fill it with (bottled) water. Spray the kids, or let them spray themselves when they (and you) get hot.

You might also find other interesting information about travelling with children at ;-
 
http://www.filosbali/BaliWithKidz.html.

 

 

You are most welcome to print off this (and any other information on our web pages) and take it with you for reference if the worst comes to the worst.

For more information about Bali, including the stories of some of our holidays and photos of the places we've been, go to our HOME PAGES.

 

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