Bali is one of the most incredible places you will ever visit! Off the charts beauty, amazing adventure, gorgeous beaches, fascinating culture, incredible food and so much more! But the quickest way to ruin your trip to paradise is to spend it in your room with a case of Bali Belly. Even if you try to tough it out, it’s hard to enjoy anything when you are running back and forth to the bathroom and feel sick as a dog. But don’t worry! Bali Belly is easy to prevent, and I have the experience and expertise to help you do it.
Not only do we live in Bali, but I am also a physician assistant with many years of experience in urgent care and family medicine. This is my wheelhouse, and I am going to prepare you to significantly decrease your chance of getting Bali Belly to begin with. And if you are unlucky and get it anyway? You’ll know exactly what to do after reading this article.
What is Bali Belly?
So the first question that you are probably asking is what is the meaning of Bali Belly anyway? Bali Belly is another name for traveler’s diarrhea. If you are in Mexico, you might hear it referred to as Montezuma’s Revenge. If you are in India, you might hear it called Delhi Belly. All of these are just cute names for the nasty business of diarrhea on vacation.
Traveler’s diarrhea occurs during or within 10 days of travel depending on the type and quantity of bacteria a person is exposed to. It’s a common problem among travelers. In fact, traveler’s diarrhea is the most common illness in people who travel from resource-rich to resource-limited regions of the world. Bali is part of southeast Asia, which is considered a high risk region of the world for traveler’s diarrhea. (Greenwood et al., 2008) I will go into all the reasons why later, but for now, the take home message is that Bali Belly could put a serious damper on your trip when it does not have to!
There is definitely a component of luck involved, but if you follow these precautions and use common sense, you should enjoy your entire holiday as healthy as can be. We live in Bali and rarely get sick, and I am going to show you how to do it.
What causes Bali Belly?
Bali Belly is usually caused by bacteria, but parasites and viruses are sometimes the culprits, too. Most often these come from ingesting contaminated food or water.
More than 90% of cases of traveler’s diarrhea worldwide are caused by bacteria. In this region of the world, Campylobacter bacteria are the most common cause of traveler’s diarrhea. (Shah et al., 2009) Escherichia coli is the next most common bacterial cause. Other common bacteria are Salmonella spp, Shigella spp, and Vibrio species.
Occasionally diarrhea is caused by viruses. When this happens, it is just good old fashioned stomach flu. Your body is smart and knows the quickest way to rid itself of the infection is to flush the gastrointestinal system (AKA vomiting and diarrhea). Everyone has experienced this type of illness, and the treatment is really no different than bacterial causes most of the time.
Bali Belly Parasite
Parasites are a risk, too, although they are an unusual cause of traveler’s diarrhea. Parasites usually result in being sicker much longer. (LaRocque & Harris, 2022a) Griff can attest to this! Griff was diagnosed with a parasite in Bali shortly after arriving from the Philippines in 2019. He spent over a week in our villa sick as a dog. He had nausea, decreased appetite, diarrhea, fever, chills and sweats. This is an example of when you should seek medical attention (which I will go into more later). Thankfully in these unusual situations, it is easy to get into an English speaking doctor, have appropriate labs performed, and get the right treatment in Bali.
How long does it take Bali Belly to kick in?
It really depends on how much bacteria you ingest. The higher the concentration of bacteria, the quicker you get sick. However, most episodes of traveler’s diarrhea occur within 4-14 days after arrival. (Stephen et al., 1999) That means that if you develop Bali Belly, there is a tiny chance you may not get sick until you are heading home or possibly even after you get home. If you do, just follow the advice you find here or contact your health care provider for help at that point.
Bali Belly recovery time
Bali Belly usually doesn’t last long. For many people symptoms will last less than a day. For example, it is not unusual to hear that someone had 1-2 episodes of diarrhea and then felt back to normal. However, typically Bali Belly will occur for 1-5 days with symptoms improving toward the end. There are things you can do to hasten recovery that I will talk about later. However, the most important one is to stay hydrated. You will feel better and recover fully sooner if you are drinking plenty of fluids. Drink more than you think you should. Your urine should stay clear to pale yellow if you are maintaining appropriate hydration.
What are the symptoms of Bali Belly?
The most common symptoms of Bali Belly include abdominal pain or cramping, watery diarrhea and decreased energy. Some people get nausea and vomiting, too. It is also not unusual to have a decreased appetite. More serious symptoms include fever, blood in the diarrhea, being sick greater than 10-14 days, severe abdominal pain, and/or the inability to eat or drink anything. If the serious symptoms are present, you should seek medical attention.
Should I go to the doctor?
The short answer is usually not. The grand majority of the time the symptoms of Bali Belly are mild to moderate and go away on their own. You should treat yourself supportively with the recommendations made here. If your symptoms are mild, you will just waste time and money going to the doctor. On the flip side, you should always seek medical treatment for severe symptoms or when your symptoms are lasting more than 10-14 days.
Now you are probably asking, “How do I know if my symptoms are mild or severe?” I am going to break it down for you here.
The International Society of Travel Medicine classifies traveler’s diarrhea symptoms as mild, moderate or severe based on the following:
· Mild- Diarrhea is tolerable. It is not distressing and does not interfere with planned activities.
· Moderate- Diarrhea is distressing and interferes with planned activities
· Severe- Diarrhea is incapacitating or completely prevents planned activities. Bloody diarrhea is also considered severe. (Maier et al., 2022)
The last thing I would add here is to listen to your gut feelings. I have practiced clinical medicine for many years, and one of the most important things I have learned is to listen to the patients. Even if research tells me that a patient doesn’t need further work-up, if the patient’s gut tells them something is seriously wrong, I listen. You know your own body better than anyone else in the world. If you feel like something isn’t right, you should listen to that feeling. The worst thing that can happen is that the medical provider will confirm that your case is not severe. However, they will be able to provide you with individualized advice on how to treat your symptoms supportively, as well as to help you to know what you should watch for at your specific point in course of the illness.
The bottom line is that you should always err on the side of caution. If in doubt, make an appointment and be seen by a medical health provider. Never be embarrassed or hesitate to advocate for your health.
Treatment for Bali Belly really focuses on supportive care. In a healthy adult, the immune system is more than capable of dealing with traveler’s diarrhea. The goal is to support your body doing it’s thing.
Drink adequate fluids
Hands down the most important thing you can do for Bali Belly is to drink plenty of fluids. You lose a lot of water and salt with diarrhea, so it is easy to become dehydrated if you are not careful. Fluid replacement should be your main focus if you end up with Bali Belly.
Clean water is a good place to start, but if you are having a lot of diarrhea, you also need to replace some of the electrolytes you are losing. Many people will reach for Sprite, ginger ale, or juice. While these aren’t horrible options, they contain a lot of sugar. High sugar drinks pull more water into the intestines, which can worsen diarrhea. If you are sipping on these in between drinks of water, you are just fine. Just don’t make a high sugar drink your main source of hydration when you have Bali Belly.
What fluids should I drink if I get Bali Belly?
Two great options to prevent and/or treat mild dehydration while you are sick with Bali Belly are Pocari Sweat and young fresh coconut water. Every convenience store in Bali has Pocari Sweat on the shelf. It is very similar to Gatorade in nutrition profile (which is not available in Bali). However, while it has less sugar than the options we discussed before, Pocari Sweat still contains more sugar than is ideal as a rehydration solution. This is not an issue if you are not dehydrated, but mixing the Pocari Sweat half and half with water might be a better option.
Young fresh coconut water is another great option in Bali. You can buy them at every restaurant, roadside stands, and even at most grocery stores. Coconut water contains electrolytes similar to Pocari Sweat, except that it has quite a bit more potassium. Limit fresh coconut water to 1-2 coconuts per day.
At the end of the day, nearly any fluid is going to be better than no fluid. So if juice is what you are craving, then get juice. If ginger ale or Sprite are all you want, then do it! Just alternate with water.
Sipping chicken broth or eating salted crackers along with your fluids are great ways to get some salt. Just remember that chicken broth has a high concentration of salt, so one bowl is enough.
These are all great ways to prevent or treat mild dehydration, but once you have become truly dehydrated, you really do need to seek medical care.
How can I tell if I am dehydrated?
Mild dehydration is easily treated with fluid replacement at home as we have just discussed. However, how do you know the difference between mild and more severe dehydration? Use your urine as a general guide. If you are urinating regularly, even if it the urine is dark yellow, your fluid loss is likely mild. However, if you are urinating infrequently and there is only a small amount of dark, yellow urine when you do, your fluid loss is more severe. Also, if you are vomiting and unable to keep fluids down, you should seek medical care.
What should I eat if I get Bali Belly?
It is not unusual for patients with Bali Belly to have a decreased appetite. It usually only lasts a few days, so as long as you are drinking plenty of fluids, it is not necessary for you to eat much. However, if you do want to try eating, start with foods that are easy to digest. Your gut is pretty irritated from all that diarrhea, so heavy meals are probably not going to go over well in your belly. Bland foods like bananas, rice, bread, and crackers are a good place to start. If you tolerate those, you can consider adding other foods including lean proteins. Avoid high fat foods like French fries, burgers, etc until you are tolerating lighter foods.
What medications should I take for Bali Belly?
Remember that Bali Belly is another name for traveler’s diarrhea. You are a traveler on vacation, and you want to get out and see Bali! So if your symptoms are mild and you feel well enough to venture out, you may be looking for medications you can take that will help with the symptoms. Just remember that these medications will NOT treat the cause of the diarrhea. They are only helping with the symptoms while your body’s immune system does its thing.
Loperamide (Imodium) is one medication choice for diarrhea. You can buy this over the counter at any pharmacy in Bali, but I recommend bringing some in your bag to buy you time to get more if you end up needing it. Loperamide is an anti-motility medication. This means it slows down how fast food and water move through the intestines, which decreases diarrhea. Remember that even though your diarrhea may decrease, it is just as important as ever to maintain hydration. So keep pushing those fluids!
Bismuth subsalicylate (Pepto Bismol)
Bismuth subsalicylate (Pepto Bismol) is another option for diarrhea, but it is not readily available in Bali. It is effective for both the treatment and prevention of traveler’s diarrhea. However it is not as effective as loperamide and the doses are large, which requires a traveler to carry large quantities of medication. It is also not safe for those taking aspirin, pregnant women or children. (Riddle et al., 2017) The bottom line is that bismuth is not a bad choice, but it is probably not as good as loperamide for Bali Belly.
Activated charcoal for diarrhea
Activated charcoal pills are pushed heavily in Bali for treatment of diarrhea. Pharmacies will always offer you this, and many locals and expats will recommend it. I reviewed all the current literature, and there is no good evidence to support using activated charcoal for diarrhea.
Activated charcoal is used in the emergency room for specific types of poisoning as it binds certain toxins in the gut, preventing their absorption. When used for diarrhea, the hope is that the charcoal will do the same thing with the bacteria that is causing Bali Belly. But there is not any evidence to support this.
One of the side effects of activated charcoal is constipation (Lexicomp, 2022), so one theory is that this side effect is contributing to some relief with diarrhea associated with Bali Belly. Further research is needed to find out if this is true or if there is any other truth to the claim that activated charcoal helps with traveler’s diarrhea.
One other issue to be aware of with activated charcoal is that it may decrease the absorption of other medications. So if you are taking any medications, check with your doctor before you try activated charcoal for diarrhea.
If you are otherwise healthy, do not take any medications, and want to try activated charcoal, it is probably safe. However, experts in the field specifically do not recommend the use of activated charcoal for traveler’s diarrhea at this time. (Riddle et al., 2017)
Antibiotics for Bali Belly
Mild to moderate diarrhea associated with Bali Belly should NOT be treated with antibiotics. If the cause is viral, antibiotics will not help at all.
While the use of antibiotics might shorten the duration of diarrhea in bacterial causes, research shows that the risks associated with antibiotics far outweigh the benefit for otherwise healthy individuals. (LaRoque & Harris, 2022b).
The overuse of antibiotics can kill off the good bacteria in your gut, lead to prolonged illness, and result in other serious adverse effects. Inappropriate use of antibiotics in individuals with diarrhea is also leading to antibiotic resistance worldwide. (Barr & Smith, 2014)
Severe cases of traveler’s diarrhea or mild to moderate cases in immunocompromised individuals may warrant the use of antibiotics. In these situations, you should seek medical care.
How do you get rid of Bali Belly?
Your body is capable of ridding itself of the bacteria that cause Bali Belly. Most of the time, it is not necessary to take anything to get rid of it. Maintain hydration, use anti-diarrhea medications as needed, and wait it out. If the symptoms are severe or if you continue to get worse, you should seek medical care.
How to see a doctor in Bali
The easiest thing to do is check with your host. Your hotel or Airbnb host will help you to set up an appointment with a nearby doctor who speaks English. Unlike the USA, healthcare is very affordable in Bali. When Griff had a parasite in 2019, we paid out of pocket without using our insurance. The cost was about $120 USD for the office visit, laboratory testing, and the medication. The doctor called us personally with results and was fantastic! Prices will vary, but the point is that the cash pay price for health care is a fraction of what it is in the United States. Having said that, it is always a better idea to travel with insurance. If medical care progresses, the cost can still rack up quickly. So we do recommend using travel insurance.
Bali Belly long term effects
Thankfully there are rarely long term effects related to Bali Belly. You get sick, you endure it while it lasts, and then it goes away forever. If you continue to have symptoms after experiencing Bali Belly, you should follow up with your medical provider.
Bali Belly prevention
Bali Belly can ruin your trip, but it does not have to! Millions of people come to Bali every year and only a tiny fraction of them get sick. Bali Belly is largely preventable if you follow these tips!
Wash your hands
This one is simple. Everything you touch is a risk for contacting a germ that can make you sick. One of the very best ways to avoid Bali Belly is to wash your hands frequently. Carry a small hand sanitizer for when washing your hands isn’t possible. And definitely always clean your hands before you eat!
Don’t drink the tap water in Bali
Unless you boil it, tap water in Bali is not safe. Those who drink it risk getting Bali Belly. Don’t drink it. Don’t brush your teeth with it. Don’t use it to wash your food.
You can buy individual water bottles, but we recommend avoiding this since single use plastic is horrible for the environment. The best thing to do when you go out for the day is bring your own water bottle. Most Airbnb’s, hostels, and hotels buy water in 19 liter (5 gallon) refillable jugs. Take advantage of using these whenever possible!
We recommend an insulated bottle to keep the water cold, as well as a water bottle with a good filter. The Grayl Geopress is our favorite pick, because of ease of use and the best filter on the market. It filters 99.9% of waterborne pathogens – including bacteria, protozoa, AND viruses. In Bali, viruses are just as big of a risk as bacteria and protozoa, so it is really important to have a water purifier that covers these.
I wrote a full blog post about the water situation in Bali that will answer all your questions! Click here.
Tips for eating out to avoid Bali Belly
The foodie scene in Bali is off the chart! Seriously, you should consider coming to Bali even just to eat. I’m planning a blog post to tell you all the best spots to hit, but for now just know that you should eat out. A lot.
Restaurants in tourist areas use filtered water in their kitchens, and you can eat and drink without worrying about getting Bali Belly.
The risk for getting traveler’s diarrhea increases with eating street food, but that does not mean you should avoid street food and local warungs (restaurants) altogether! Some of the best food in Bali comes from the local spots!
Here are some tips for choosing the right food stand or warung:
1. Look for long lines! Long lines mean the restaurant has a good reputation. Usually this means good food and good hygiene. They wouldn’t be that busy if all those people in the long lines were getting sick.
2. Eat hot food hot. Food that has been sitting, especially meat, is higher risk for getting Bali Belly. Make sure that food is cooked fresh and then eat it hot.
3. Look for at least two employees. More than one person working allows time for better hygiene. And chances are there will be one person making food and the other for handling the money.
4. Look at yourself: Remember that your own two hands have been touching all sorts of things all day. The quickest way to get sick is to forget to wash your hands, especially before eating!
Bali Belly in a nutshell
Hopefully you now feel better prepared to deal with Bali Belly. Just remember, millions of people visit Bali every year, and most of them never get traveler’s diarrhea. Be smart and follow the tips I shared, but please do not spend your vacation overly worried. Bali is an incredible place that will steal your hearts. Check out some of our guides for the best places to visit and things to do while you visit the Island of the Gods.