Bali belly: how to treat it and when to get help

What is Bali belly?

Bali belly is the popular name for travellers’ diarrhoea: three or more loose stools in 24 hours, often with cramps, nausea, vomiting or a fever.^[1]

Bacteria cause most cases, and viruses or parasites the rest. Infections spread by food and water are widespread across Indonesia.^{[2, 3]}

It is common. Depending on the destination and the season, 30% to 70% of travellers get it over a two-week trip.^[2]

How long does Bali belly last?

Most bouts last three to four days and stop without treatment. It usually starts in your first week, and about one case in a hundred lasts longer than a month.^[1]

The cause changes the length. A virus tends to pass in two or three days and bacteria in three to seven, while a parasite can hang on for weeks.^[2]

It can also start after you fly home: symptoms can appear up to 10 days after you get back.^[1]

How do you avoid Bali belly?

You lower the risk with what you eat, drink and touch, but no habit removes it.^[2]

Hands come first. Wash them with soap and water before you eat, and carry a hand gel of at least 60% alcohol for when there is no sink.^[4]

Then choose food and drinks by how they were made; water, ice and brushing your teeth have their own page. The table sets the lower-risk choice against the higher-risk one.^{[4, 5, 6, 13]}

How do you treat Bali belly?

Treatment is mostly fluids and rest, because the main danger is losing too much water.^[7]

When should you see a doctor for Bali belly?

Get medical help at once if any warning sign below appears, and see a doctor anyway if you are no better after three days.^[1]

A fever in Bali can also be dengue, so take paracetamol for it, not ibuprofen or aspirin, until a doctor has ruled dengue out.^{[3, 11]}

Dehydration signs mean going to a doctor or the nearest puskesmas (public community health centre) at once. For an emergency, call 118 and ask for an ambulance, then phone your insurer.^{[1, 6, 8]}

Sources differ on how soon to go; see Conflicts.^[3]

When should you take antibiotics for Bali belly?

Take antibiotics only when a doctor prescribes them. Mild diarrhoea does not need them; severe diarrhoea, or any with blood, needs medical care, and the doctor decides.^{[2, 8]}

A standby course to carry is a call for your own doctor before you travel. It suits people at higher risk or heading somewhere remote, and some older antibiotics are no longer advised for it.^[1]

Is it Bali belly or methanol poisoning?

Methanol poisoning can look like a bad night’s drinking, and it kills. There have been cases in Bali, and travellers in Indonesia have died or fallen seriously ill after drinks bought in licensed bars, shops and hotels in tourist areas.^{[3, 9]}

You can’t taste or smell it, fake copies of known brands can carry it, and as little as one shot can be fatal. A licence is no guarantee, so the safer drinks are branded beer, wine or premixed drinks in sealed bottles or cans. Take care with spirits, shots, cocktails and buckets, and skip free drinks and homemade or street-side alcohol.^{[3, 9, 10]}

The first signs look like being drunk, only stronger: vomiting, drowsiness and loss of balance. Blurred vision, a glare from bright light, belly pain or breathlessness can follow 12 to 48 hours after drinking. Treatment works best within 10 to 30 hours, so don’t sleep it off.^{[3, 10]}

What should you pack for Bali belly?

Pack oral rehydration sachets for any trip; the rest of the list depends on who is travelling and what your doctor advises.^{[1, 4, 6, 12]}

Two infections spread by food and water have vaccines. Hepatitis A vaccine is recommended for unvaccinated travellers aged one and over, and typhoid vaccine for most travellers, though it does not protect fully. Check what you need at least eight weeks before the trip.^{[6, 12]}