Bali belly symptoms: what to look for, and when to get help

The symptoms, in the government's words

The Better Health Channel lists the symptoms of traveller's diarrhoea as abdominal bloating, cramps and pain, nausea, urgency to go to the toilet, loose watery stools passed frequently, a mild temperature, and general malaise.

Most people get some of that rather than all of it. Vomiting is common but not universal, and tends to be an early feature that settles within a day or two while the diarrhoea continues. The defining symptom, and the one with an actual threshold attached, is the diarrhoea itself.

Diarrhoea is when you have 3 or more loose or liquid stools (poos) in one day, or more frequently than normal.

Three in a day, or more often than is normal for you. Below that you may just be having a bad morning, which is worth knowing before you cancel a day you have paid for.

The red flags, and they override everything

healthdirect is specific about when to seek medical attention, and these are not judgement calls. Any one of them means go, whatever day of the illness you are on and however much you had planned.

• Severe diarrhoea, rather than frequent but manageable.
• Signs of dehydration: feeling tired, passing much less urine, thirst, a dry mouth. In a child, also no tears when crying, a sunken soft spot in a baby, and unusual drowsiness.
• Heavy rectal bleeding, or blood or mucus in the stool at all.
• Diarrhoea with severe abdominal pain.
• A fever, particularly a high one.
• Not being able to keep fluids down, which turns a manageable illness into a dehydration problem quickly.
• Unexplained weight loss, or diarrhoea that wakes you at night.

Dehydration is the mechanism behind almost everything that goes seriously wrong here, and it moves fastest in babies, young children and older travellers. If you are unsure from Australia, healthdirect's nurse line is 1800 022 222, 24 hours.

Is it Bali belly or food poisoning?

Largely the same thing described from different angles, which is why the distinction generates more search traffic than it deserves. Food poisoning describes the route, illness from contaminated food. Traveller's diarrhoea describes the situation, the illness you get away from home. A single plate of bad satay can honestly be called both.

There is a rough timing tell, and it is rough. Illness from a preformed bacterial toxin tends to arrive fast, within hours, hit hard with vomiting, and be over inside a day. Infection with an organism that has to multiply first usually takes a day or two to appear and lasts longer. Neither is reliable enough to act on, and the treatment is identical: fluids, rest, and the red flags above.

What genuinely is a different illness is a parasite, because the timeline and the treatment both change. See Bali belly or a parasite.

Things that get mistaken for it

That last card is the reason not to self-diagnose a fever as Bali belly. Staying healthy in Bali covers mosquito-borne illness and vaccinations for Bali covers what to discuss with a GP before you go.

Symptoms in children, where the bar is lower

Children get dehydrated much faster than adults and cannot reliably tell you how they feel. The signs to watch are fewer wet nappies or much less urine, no tears when crying, a dry mouth, unusual sleepiness or floppiness, and in babies a sunken soft spot on the head.

healthdirect is explicit that anti-diarrhoeal medicines should not be used to treat diarrhoea in children. Rehydration solution, offered little and often, is the whole home plan, and a doctor sooner than you would go for yourself. Bali has clinics that will come to your accommodation, which is far easier than a taxi with a sick toddler.

Bali with kids has the practical detail, including sterilising bottles and making up formula with water you can trust.