Bali offers unforgettable experiences for travellers thanks to its year-round warm weather, affordable resorts and cheap drinks.
But there are other moments tourists might rather forget, like becoming sick with the dreaded “Bali belly”.
About 1.5 million Australians visit the Island of the Gods in Indonesia annually, perhaps for a quick getaway or to immerse themselves in a yoga retreat.
So chances are that either you, or someone you know, has experienced Bali belly.
If you’re planning a trip over summer here’s what you should know about the illness before it ruins your holiday.
Experts say maintaining personal hygiene while travelling is an important part of avoiding getting sick. (Flickr: Jorge Franganillo; licence)
What is Bali belly?
Bali belly is not unique to Bali but it’s an informal phrase for a real illness.
In simple medical terms it is traveller’s diarrhoea, mainly caused by bacteria or viruses, said Debby Sartika Mahardhika, a doctor from Sanur Medical Clinic in Bali.
Escherihia coli, or E. coli, is one of the most common bacterial causes of traveller’s diarrhoea, according to Victoria’s Health Department.
In cases where diarrhoea persists for several days it may be due to parasites or linked to a viral infection, the department notes.
Symptoms vary between patients, and also include cramps, bloating, nausea and vomiting, said Dr Mahardhika.
Other colloquial names for traveller’s diarrhoea include “Delhi belly” and the “Rangoon runs” used by tourists to Myanmar and surrounding areas.
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What causes Bali belly?
Dr Mahardhika said eating contaminated food or drinking contaminated water was one of the main causes.
“Always choose freshly cooked food from restaurants and avoid food that’s been sitting out on the display or in the streets,” she said.
Debby Sartika Mahardhika says during peak holiday season her clinics treat hundreds of international tourists for Bali belly. (Supplied)
Dr Mahardhika said it was also important to note that Indonesia had a different climate to most parts of Australia.
“Be cautious when you have leftovers or takeaway, don’t let [the food] sit out for too long.”
The warmer weather and humidity make bacteria grow quickly, she added.
Dr Mahardhika said Australian tourists often forgot that tap water in Bali, and in Indonesia more broadly, wasn’t safe to drink.
She said it was always better to stick to bottled water and even use it when brushing and rinsing your teeth.
“And avoid iced drinks sold on the street. It’s better to choose cold drinks from the fridge.”
Personal hygiene also played a significant role, Dr Mahardhika said, so it is crucial to wash your hands before meals and after using the toilet.
Other things like accidentally swallowing contaminated water while swimming or rafting could also make you sick, she said.
What if you get Bali belly?
Dr Mahardhika runs three medical clinics in the tourist hotspots of Sanur, Canggu and Seminyak.
She told the ABC that during peak tourist seasons each of her clinics treated more than 100 international tourists with Bali belly.
Bali might not seem complete without iced drinks, but it’s safer to choose cold drinks from a fridge. (Reuters: Nyimas Laula)
“The first thing to do when you have Bali belly is to make sure you don’t become dehydrated. You can also take anti-diarrhoea medication,” she said.
“If you’re going to toilet more than six times a day, can’t take any food or drink, vomit, or develop a fever, you have to visit a doctor.”
What about having spicy food?
If you are recovering from Bali belly Dr Mahardhika said tourists should avoid foods that can cause an upset stomach, like those “with too many spices”.
“It’s also a good idea to consume probiotics to help fight bad bacteria in your gut,” she added.
She explained that if a tourist was getting diarrhoea after eating spicy Balinese food it could be due to a person’s “food tolerance”.
“Our stomach is accustomed to our usual habit, so any sudden changes can cause digestive upset, such as acid reflux,” she said.
“When your stomach is used to mild or lightly seasoned food and [you] suddenly eat something very spicy it can upset it and cause diarrhoea.”
Bali belly is a colloquial name for traveller’s diarrhoea. (ABC News Graphic: Jarrod Fankhauser)
What else is there to consider?
You might think that traveller’s diarrhoea only happens when you visit developing countries.
But that’s not the case, Dr Mahardhika said.
“When we travel to places, not only to Bali, we’re constantly on the move, doing different activities, so our bodies can become fatigued,” Dr Mahardhika said.
“That tiredness can weaken our immune system,” she said, explaining that made a person more likely to get sick.
Dr Mahardhika said it could be beneficial for the immune system to get a good amount of rest, and potentially supplementing nutritional gaps with vitamins.
She also said it was a good idea to bring a supply of your own basic medications to treat things like digestive issues.
