Holidays
Inflammatory bowel disease is a diarrhoeal illness and even people with the strongest guts may suffer diarrhoea on holiday. It is therefore most important to select a destination wisely when considering a holiday.
Listed below are some helpful tips on things to consider before going on holiday and how to ensure you remain well once you arrive.
Select a Suitable Destination
Choosing a suitable destination could mean the difference between a disastrous holiday and perfect heaven. Choosing unwisely could also prove extremely expensive in terms of a holiday wasted and possible medical expenses. Holidays in UK may generally pose few problems as relatively little is changed environmentally. However, holidays abroad are very different and destinations that are renowned to have poor hygiene are generally not recommended. If you must travel to these places ensure that the accommodation is of the highest possible standard.
Travel Insurance
Ensure that you have a comprehensive travel insurance policy before you travel abroad, and that pre-existing medical conditions are not excluded. Do not travel against the doctor's advice as this may make the policy void and a letter from the doctor would be helpful. Shop around for the most suitable and least expensive policy - some companies will be more sympathetic than others towards chronic illnesses.
Mode of Transport
This is very important in terms of availability and accessibility of toilet facilities.
Medications
Ensure that you take all your current medicines with you and in good supply as these may not be available if you run out. These should be kept in hand luggage for easy availability. Your doctor will be able to give you advice on the use of short-term anti-diarrhoeal tablets to avoid accidents whilst travelling. (The regular use of such medications is generally not recommended as they can cause complications of the disease). Instructions may also be given on taking steroids should you experience a flare-up whilst abroad.
Food and Drink
A change in environment may change your tolerance to foods and so you should be extra vigilant whilst abroad. The general rule is not to eat anything that you would not eat at home. Exotic and highly spiced foods may cause the bowel to be upset.
- Increase the fluid and salt intake in hot climates to avoid dehydration.
- Check if the local water is safe to drink, if not use bottled water for drinking and cleaning the teeth. Fizzy water is safer as some unscrupulous proprietors may decant their tap water into empty water bottles and re-cap them.
- Choose fully cooked food whenever possible and avoid cold foods. Salads and fruits should be washed in bottled water if self- catering.
- Avoid ice cubes (frozen local water!) and ice cream.
- Peel all fresh fruit yourself.
- Ensure that you have a supply of anti-diarrhoeal tablets such as Imodium, should diarrhoea occur. Even better, have a small supply of a rehydration agent such as Dioralyte.
- If your IBD is being treated by diet, ensure that you have a supply of elemental diet with you.
Prophylaxis and Travelling Abroad
Although most people can enjoy foreign travel today, in order to remain healthy it may be necessary for you to take precautions against conditions which have a particular prevalence in certain countries, i.e. you may require vaccinations before you travel or need to take anti-malaria tablets. Your GP will be able to advise you about which vaccinations to have, or if you will need to take anti-malaria tablets.
General considerations when travelling abroad
- Before travelling, you need to be aware of the risks involved in entering certain regions and, although most vaccines are only recommended rather than compulsory, make sure you are aware of the risks of not being vaccinated.
- Immuno-compromised patients should carry a letter detailing their condition and treatment and, ideally, a contact number of the physician in charge of care. If you are carrying supplies of drugs or elemental diet, a letter from your doctor which you can show to airport authorities may be necessary.
- It is advisable that travel insurance covers medical evacuation to the nearest region with adequate medical facilities should you be unfortunate enough to fall ill abroad.
Make sure you are familiar with the procedure for obtaining medical treatment or making an insurance claim. Free emergency medical treatment can be obtained in EU countries. Health advice for travellers and the E111 form can be obtained from the Post Office. This should be completed by you and stamped by the Postmaster before you travel and should be taken on holiday with you.
Coach: Some long-distance coaches have toilet facilities on board and this is worth checking prior to booking. Coaches used in transportation from the airport to your resort destination generally may not have these facilities so check transfer time from the airport when deciding on a holiday.
Rail: It is usually possible to book a seat near to the toilet when travelling by train. Check that this is possible if travelling abroad.
Ferry: Information giving details of toilet facilities at ports and on board ships is available from the reservations office of ferry companies. Stena Sealink has produced advice leaflets containing these details for all of its routes.
Air: Air travel can cause difficulty in gaining quick and easy access to the toilet. It is possible to pre-book a seat which is near the toilet. Most airports have information services and booklets giving details of medical centres and location of toilets.
Car: There is a system which enables drivers who hold a special key to have access to toilets not available to other people and therefore the chances are that you will not have to wait, (they are also less likely to be vandalised and are cleaner). To purchase or hire one of these keys contact: The Royal Association for Disability and Rehabilitation or RADAR. Tel: 020 7250 3222.
General recommendations include:
Special precautions need to be considered if you are taking medications which lower the immune response of the body, e.g.corticosteroids, 5-ASA preparations (mesalazine, olsalazine, Salazopyrin) or azathioprine (Imuran). A patient would be considered immunosuppressed if steroids have been taken at a dose of 40mg per day for more than one week or lower doses of steroids or other immuno-suppressants have been given for long periods of time.
Patients who are immuno-suppressed should not receive live vaccines until at least three months after treatment has stopped, or three months after levels have been reached which are not associated with immuno-suppression. If dead vaccines are administered to patients who are immuno-suppressed the antibody response may not be sufficient to provide protection against the infection.
Many patients with inflammatory bowel disease are also upset by taking anti-malarial tablets. Unfortunately, these must continue as there would be a risk of contracting malaria if stopped.