How to manage Bali Belly
What is Bali Belly?
Bali Belly is one of Bali’s least popular attractions, but unfortunately it is all too common among visitors to the island. Bali Belly is just another expression for food poisoning (or stomach flu/gastroenteritis medically speaking). Gastroenteritis is technically an inflammation of the stomach, but most people would recognise it by its more well-known symptoms: diarrhoea and/or vomiting1. These often come with a side of stomach cramps, fever, chills and loss of appetite, bloating, and flatulence2. In short: it lays you out and makes you feel like the end might just be near. Thankfully, the episodes of acute diarrhoea/vomiting are usually mild and self-limited, meaning the body will recover on its own. Below we outline the causes, symptoms, and how to manage Bali Belly if it hits while you’re on vacation.
Causes of Bali Belly?
The most common cause of gastroenteritis (Bali Belly) is a virus, which accounts for 70% of the cases1. Contaminated food and water are the biggest culprits for carriers, and keep in mind it is not necessarily the last meal you ate: symptoms can appear as soon as one hour after ingestion, and up to 48 hours later (and even weeks later in some cases)1,3.
Scientists have already identified over 20 types of viruses to blame for these bouts, however, Rotavirus is still the most common culprit. Another common one is Norovirus4,5. Keep in mind, with viral gastroenteritis, antibiotics are of no help.
Bacterial infections are more often associated with travel, comorbidities (the presence of one or more affliction concurrently), and foodborne illness4. If you want to name names, Salmonella, Campylobacter, Shigella, Shiga toxin–producing, Escherichia coli (enterohemorrhagic E. coli) are some of the more common bacteria found later in stool analysis3. Although less common, another cause of foodborne illness is sometimes harmful toxins and chemicals which have contaminated foods5.
Many bouts of gastroenteritis resolve themselves, however, signs that further treatment is required include profuse diarrhoea with dehydration, bloody stools, fever >38.5°C (>101°F), duration >48 hours without improvement, recent antibiotic use, new community outbreaks, and severe abdominal pain. Individuals who are elderly (>70 years) or have immune systems weakened from medical conditions are also at a higher risk of complications, so should seek medical assistance earlier3-5.
How do you know if you are dehydrated? Look out for increased thirst, a marked decrease in urination, a very dry mouth and throat, and/or feeling dizzy when standing up3,4,6. When symptoms are not resolving on their own, it is time to order a microbiologic stool test. This allows the doctor to better identify any bacterial pathogens, so they know what they are dealing with and can prescribe a treatment with more accuracy.
Because acute diarrhoea often resolves on its own and is caused by a virus, routine antibiotic use is not recommended for most adults with nonsevere, watery diarrhoea2,3. In addition, the overuse of antibiotics can lead to bacterial resistance, the harmful eradication of normal gut flora, prolonged illness, induction of toxins, and last but not least, more expensive treatment for the patient3.
Oral rehydration is the first step to treating acute diarrhoea whenever possible. A mixture of salt and sugar in combination with water is preferred to replace the loss of electrolytes.3 This can be made at home by mixing 1/2 teaspoon of salt, 6 teaspoons of sugar, and 1 litre of water, however, over the counter, pre-packaged oral rehydration solution (such as Hydralyte) is widely available in local pharmacies and is a bit more palatable than the homemade variety.
Antidiarrheal tablets such as Attapulgite with or without kaolin or pectin and activated charcoal can also be helpful.3,4 Other treatments are usually given for specific symptoms, such as anti-nausea, painkillers or antipyretic (fever reducers). Changing the diet to be gentle on the stomach is also encouraged to help a more rapid recovery. Doctors advise avoiding food with spices and oil (eg. nasi campur, suckling pig etc.), dairy products, alcohol, as well as limiting both vegetable and fruit intake (except apples since they have stool hardening properties from the pectin they contain). Although limited research is available, taking probiotics during/after diarrhoea has also been proven to help, with the potential to shorten the period of illness and reduce the severity of the symptoms3,7,8
IV therapy for Bali Belly
If oral rehydration is not staying down, or it is but dehydration signs are still present, intravenous (IV) rehydration should be considered1,3,4. A course of IV rehydration and therapy may help stave off dangerous dehydration2,9. IV rehydration not only replaces lost fluids and electrolytes, but medication can be added intravenously (which means it will not be vomited up and will get to work immediately).
We recommend our Food Poisoning Recovery IV for this, and can also send our doctor to the booking if needed. Medications such as anti-nausea, painkillers and/or stomach protectors can be added to the IV to help relieve those symptoms faster. Post-IV, oral rehydration for maintenance of fluids and electrolytes should still be administered9. If, after the advised course of treatment symptoms continue to worsen or any altered mental state occurs, a visit to the emergency department is recommended.
1.Chow CM, Leung AK, Hon KL. Acute gastroenteritis: from guidelines to real life. Clin Exp
Gastroenterol. 2010 Jul 15;3:97–112.
2.Publishing HH. Gastroenteritis In Adults [Internet]. Harvard Health. [cited 2019 May 2].
Available from: https://www.health.harvard.edu/a_to_z/gastroenteritis-in-adults-a-to-z
3. Barr W, Smith A. Acute Diarrhea in Adults. Am Fam Physician. 2014;89(3):180–9.
4. Longo DL, editor. Harrison’s principles of internal medicine. 18th ed. New York: McGraw-Hill; 2012. 2 p.
5. CDC. Foodborne Illnesses and Germs [Internet]. Centers for Disease Control and
Prevention. 2018 [cited 2019 May 2]. Available from: https://www.cdc.gov/foodsafety/foodborne-germs.html
6. CDC. Signs and Symptoms of Food Poisoning [Internet]. Centers for Disease Control and Prevention. 2019 [cited 2019 May 2]. Available from: https://www.cdc.gov/foodsafety/symptoms.html
7. McFarland LV, Goh S. Are probiotics and prebiotics effective in the prevention of travellers’ diarrhea: A systematic review and meta-analysis. Travel Medicine and Infectious Disease. 2019 Jan;27:11–9.
8. Islam SU. Clinical Uses of Probiotics. Medicine. 2016 Feb;95(5):e2658.
9. Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clinical Infectious Diseases. 2017 Nov 29;65(12):e45–80.