Medical Travel Tips: Inflammatory Bowel Disease

Dr Ruth Handford's Tips for Crohn’s Disease and Ulcerative Colitis

Inflammatory bowel disease (IBD) is a term used to describe diseases which cause inflammation in the digestive tract. Doctors usually use this term to encompass two main conditions, Crohn’s disease (which can affect any part of the gut), and Ulcerative Colitis (which is limited to the lower part of the gut, the colon).

These types of conditions can flare up intermittently, causing abdominal pain, a feeling of being generally unwell, and diarrhoea. They can cause damage to the bowel, which may result in the need for surgery to remove part of the bowel. Usually, the conditions are controlled with medication which helps to stop the bowel becoming inflamed by suppressing the immune system.

Remember, you can enjoy your trip!

By considering what could go wrong, and the challenges you might face, you can prepare and plan so as to manage any flare up easily should the need arise. Having done that, you can relax and enjoy your holiday!

Here are some things to bear in mind when travelling with Crohn’s or Colitis:

Changes in water, food and climate can upset anyone’s bowels. If you suffer with IBD then you may be more susceptible to these changes. It is worth thinking ahead to try to prevent a flare up from affecting your holiday.

Many people with IBD travel extensively and without limitations, and with the correct planning and preparation, there is no need to avoid travel abroad.

Where can I go?

Think about where you WANT to go, and then think about how that might affect your IBD. It may be that you can identify obvious triggers, such as particular foods or hot weather, and can mitigate for them in advance.
If you are prone to regular flare ups then consider the need to be near toilet facilities and medical care if required. If you take medication that affects your immune system, that may have an impact on the immunisations that you can receive, which in turn, may limit your destination options.

Lots of people with IBD have a stoma bag to look after, and this may be more difficult in remote areas or on long journeys. Consider breaking up your journey to allow regular access to bathroom facilities, or at least pre-booking a seat on a plane or coach to allow easy access to the toilets.

Medication considerations and possible complications

As mentioned above, lots of the medications to control IBD do so by affecting the immune system. This can reduce our ability to fight infection and disease.

Some medications, such as azathioprine, can make you extra sensitive to the sun, so use very high factor sunscreen and reapply regularly.

Check which vaccines you need for your chosen destination well in advance. You may be advised not to have some ‘live’ vaccines if your immune system is suppressed. If these are compulsory for entry to your country of choice, you may need to reconsider your destination.

Carrying and storing medication on holiday

Make sure you travel with an adequate supply of medication, including plenty in your hand luggage in case your baggage is mislaid in transit. Keep your medications in their original packaging so they can be easily identified, and keep a copy of your repeat medication list with you in case you need any extra whilst away.
Some medication for IBD is given by injection. Make sure you have plenty of clean sterile needles for the duration of your trip, and a proper device for disposing of used needles. It is sensible to take a letter from your doctor detailing your medication and the need to carry sharps with you on your journey, particularly if you are flying.

If your medication needs to be kept cool, chat to your pharmacist about travel fridges and chilled storage containers that are available to buy.

Additional supplies of non-medical essentials may also be needed – such as stoma bags and adhesive. If you need to use scissors to cut your stoma bags make sure you pre-cut plenty prior to travelling by air. You will not be allowed scissors in your hand luggage!

Plan ahead for a flare up

Discuss a flare up plan with your IBD specialist nurse or GP. It is sensible to plan ahead in case of a flare, so you can start treatment quickly. Your doctor should be happy to give you some ‘just in case’ medication to take with you.

It is sensible to take some simple over the counter medication with you too – such as anti-diarrhoea medication, anti-spasm medication, rehydration sachets and painkillers, just in case. Have a chat with your pharmacist about what might come in handy, or take a supply of remedies you know have helped with symptom relief in the past.

Changes in climate and food

Hot weather and humidity will increase the risk of dehydration, which could cause a change in bowel habit. Be aware of the need to drink more fluids when in a hot environment. Make sure water is bottled, including the water you use to clean your teeth! Avoid ice in drinks and ice cream products, and try to steer clear of roadside foods. Diarrhoea can be a real problem for anyone, but if you use a stoma, this can prove very tricky and limiting.

Being hot and sweaty may also affect how well your stoma adheres, so travel with extra supplies, spare clothing, and wipes, just in case.

How to deal with a flare up on holiday

Flare ups in IBD usually involve abdominal pain and diarrhoea, which can sometimes contain blood. If you have vomiting with this, you must see a doctor straightaway.
If you have pain that cannot be managed with the painkillers you usually take, or that is getting worse, make sure you see a doctor. If the medication you usually use for flare up is not working QUICKLY, you must see a doctor.

Make sure you stay well hydrated during a flare up and use rehydration sachets to do this if possible. If you do need to see a doctor whilst away, make sure you have a copy of your medication list with you, and if possible, a brief medical summary. Your GP should be able to provide this. Make sure you have your own GP’s contact details with you, and your IBD nurse if you have one, so you or your doctor abroad can contact them for additional information if needed.

Travel insurance cover for Crohn’s disease and Colitis

Make sure you have travel insurance in place to cover any unexpected emergency medical treatment whilst you are away. You will need to declare your inflammatory bowel disease as well as any other existing medical conditions you may have to ensure you are fully covered.

Always consult your own doctor before travelling

These travel tips are intended to provide general information to those with irritable bowel syndrome (IBS). They do not replace a visit to your doctor . If you are planning a holiday you should consult your doctor to ensure that you are fit to travel and discuss any specific health requirements you may have.

About Dr Ruth Handford

Dr Ruth Handford is a GP with over 10 years' experience of working in both hospital and primary care. She is particularly interested in caring for the elderly in the community, child health, and family planning. Ruth lives and works in a rural community, and is kept very busy by her job and young family.

Important Information: These travel tips are intended to provide general information to those with eczema, psoriasis and other skin conditions. They do not replace a visit to your doctor . If you are planning a holiday you should consult your doctor to ensure that you are fit to travel and discuss any specific health requirements you may have.