Bali Belly: How to Avoid It and What to Do If You Get It

What Bali Belly actually is

"Bali Belly" is the local name for traveler's diarrhea: cramps, loose stools, nausea and sometimes vomiting or a mild fever, usually starting a day or two after you eat or drink something contaminated. The culprits are bacteria such as E. coli and salmonella, viruses, and less often parasites such as giardia or amoeba. Most cases pass on their own in one to three days with rest and fluids. A minority do not, and that is where knowing when to see a doctor matters.

It is not a sign of dirty food culture. Bali eats very well. It is simply that your gut meets unfamiliar bacteria, often through water, ice or food that has been sitting out in the heat.

How to avoid it

You cannot reduce the risk to zero, but a few habits make a real difference.

• Drink bottled or filtered water only, and use it to brush your teeth. Bali's tap water is not safe to drink. Most villas and hotels provide refill dispensers.
• Be thoughtful about ice. Restaurants, cafés and bars in tourist areas generally use commercially made ice from purified water, often the cylindrical tubes with a hole through the middle. If you are at a roadside stall and unsure where the ice came from, skip it.
• Eat food that is cooked fresh and served hot. A busy warung where nasi campur is turned over quickly is often safer than a half-empty buffet where dishes have been sitting for hours.
• Peel your own fruit, and be selective with salads and smoothies at places you do not know; they can be washed or blended with tap water.
• Wash your hands before eating, and carry hand sanitizer for scooter days and beach lunches.

Some travelers swear by starting probiotics a few days before the trip. The evidence is mixed, but it does no harm.

The first 48 hours: what to do

If it hits, slow down. Cancel the Nusa Penida day trip, stay near a bathroom and focus on fluids.

Rehydration comes first. Buy oral rehydration salts, sold in Indonesia as oralit and available at any apotek (pharmacy) and in many minimarts. Mix a sachet with bottled water and sip it steadily through the day, even if you can only manage small amounts. Isotonic drinks such as Pocari Sweat and fresh coconut water help as a stopgap, but proper rehydration salts are better.

When you feel like eating, keep it bland: plain rice, bubur (rice porridge), bananas, toast and clear soup. Avoid alcohol, coffee, dairy and anything spicy or greasy until you are back to normal.

Anti-diarrheal tablets such as loperamide can get you through a flight or a long drive, but they only treat the symptom. Do not take them if you have a fever or blood in your stool, and do not use them for days on end.

When to see a doctor: our rule of thumb

This is the advice we give friends, from years of living on the island. If it lasts more than three or four days, or the vomiting has stopped but you still do not feel right, go to one of the small clinics. Do not just wait it out.

The clinic will usually run a stool test to check for parasites, salmonella or other bacteria and find out what is actually causing it. If a bacterial infection is confirmed, you will most likely be prescribed an antibiotic, and that matters, because left untreated it can get worse rather than better. Different causes need different treatment; a parasite will not respond to the antibiotic a pharmacy might sell you over the counter, which is why testing first beats guessing.

A clinic visit is quick, many clinics are open around the clock, and several will send a doctor to your villa or hotel. Bring your passport and travel insurance details.

Clinics around Bali

These are established clinic and hospital groups with several locations on the island:

• The Medical: clinics in Canggu (Batu Bolong), Berawa, Pererenan and Ubud, offering lab tests and home visits.
• BIMC Hospital (part of the Siloam group): 24-hour hospitals in Kuta, Nusa Dua and Ubud, used to treating foreign visitors.
• Siloam: Siloam Hospitals Denpasar on Sunset Road near Kuta, plus the Siloam Medika clinic in Canggu.
• Unicare Clinic: locations in Nusa Dua, Uluwatu and Ubud.
• Kasih Ibu Hospital: hospitals in Denpasar, Kedonganan near Jimbaran, Saba in Gianyar, and Tabanan.
• BaliMéd Hospital: hospitals in Denpasar, Singaraja, Negara and Karangasem.

Opening hours and services change, so call ahead or check the clinic's website or Google listing before you go.

When to go to hospital urgently

Skip the wait-and-see approach and go straight to a hospital emergency department, or call 112 or 118/119 for an ambulance, if you notice any of the following:

• Blood in your stool, or black, tarry stools
• A high fever, around 39°C (102°F) or higher
• You cannot keep fluids down at all
• Signs of dehydration: very little or dark urine, dizziness when standing, a racing heart, a very dry mouth, confusion or extreme fatigue
• Severe or worsening abdominal pain

The threshold is lower for young children, older travelers, pregnant women and anyone with a chronic illness. For a baby or toddler, fewer wet diapers, unusual sleepiness or refusal to drink means a doctor today.

Water and ice: a quick recap

Bottled or filtered water for drinking and brushing teeth. Commercial ice in established venues is generally fine; ice of unknown origin is not worth the risk. Fresh, hot food over food that has been standing. And if it does catch you, rehydrate early, rest, and see a clinic if it drags past three or four days.

This article is general travel information, not medical advice. If you are unwell, see a qualified doctor.