Achieving more with IBD

Travel

Top tips

• Be prepared
• Be realistic about your destination and what you can manage
• Stick to the diet you usually follow at home
• Only drink bottled drinks or cans and avoid uncooked foods
• Ensure you have enough medication for the duration of your holiday, plus some extra
• Learn the generic name of your medication
• Make sure you have adequate travel health insurance
• Take copies of prescriptions/official letters confirming you are allowed certain drugs or devices
• Taking a summary of your medical records can be useful
• Look up the Travelling with IBD (TIBD) fact sheets on the EFCCA website as these can provide valuable information, such as names and contact details of IBD specialists in some European countries

While travel is possible, it does need some preparation in order to minimise any disruption your IBD may cause; indeed delegates of EFCCA, many of whom have IBD, regularly travel for EFCCA causes. Generally the same precautions apply as they would to people without IBD, and if you follow good travelling practice guidelines, and are sensible, you should enjoy yourself. Beware of planning holidays which do not fit in with your situation; for example a camping holiday, or a trip to a remote area with few medical facilities. Remember to plan your journey and be in control.

Countdown to your holiday                                                         back to top

This checklist should help you prepare for your holiday:

To download a PDF version click here

Diet and travelling                                                                                    back to top

Stick to the diet you usually follow at home as far as you can, unless you feel confident about trying something new. If you can tolerate spicy food etc., generally foreign and spicy foods should not exacerbate your IBD.

Everyone is at increased risk of picking up diarrhoea (‘traveller’s tummy’) when travelling abroad. This can be caused by food and water containing unfamiliar or harmful bacteria, parasites or viruses. By applying a little common sense you can minimise the risk of contracting this:

• Only drink bottled water. If this is unavailable, make sure that drinking water is boiled
• Use bottled water for brushing teeth or washing food
• Stick to bottled drinks or cans and avoid draught drinks (beer/lager is the exception here), and drinks which are reconstituted from cordials, syrups or powders
• Avoid ice cubes, as frozen water is probably made using local supplies
• Avoid water-containing foods, such as ice cream
• Avoid uncooked foods like salads, raw vegetables, eggs and fish (especially shellfish) as well as undercooked and reheated foods
• Avoid food from street vendors

Should you develop diarrhoea, or an increase in stools, it is important to remain hydrated, so take care to drink enough fluids.

Medication and travelling                                                                     back to top

Make sure you have enough medication for the duration of your holiday and take some extra in case you need them. Medications that you use regularly to treat minor symptoms (e.g. pain relievers, anti-diarrhoeals or antacids) should be discussed with your healthcare practitioner. He/she should be able to write you a prescription for extra medication using the generic name (which is the same for all countries and manufacturers) as well as a medical report or letter explaining your condition and the medication you are taking. Remember to share your travel plans with your healthcare practitioner, particularly if you are planning to stay away for longer than 1 month.

It can also be helpful to clarify the times that you need take your medication when travelling through different time zones.

Storage and transport of your medication is important. When flying, keep prescriptions in their original bottles and take your medication in your hand luggage if possible, bearing in mind that rules for international flights mean that all liquids, aerosols and gels that you take in your carry–on baggage must be in containers of 100ml or smaller. Any containers larger than 100ml will need to be packed into your check-in baggage.

You are also advised to check the import regulations in the country you’ll be visiting – your Foreign and Commonwealth Office (FCO) may be able to provide this information. These precautions will make it easier when dealing with customs officers or other officials.

Some medication needs to be refrigerated. If no fridge is available, store your medication in a cool box/bag with an ice pack. If your medication is temperature critical it may be advisable to buy a new supply at your destination, but check if it is available before you travel.

Before deciding on your destination it is important to find out whether vaccinations are needed as some vaccines may not be compatible with your medication. Immunosuppressant drugs like azathioprine weaken your immune system so live vaccines like polio and yellow fever should be avoided. Check with your healthcare practitioner before getting any vaccines.

Anti-malaria medication is necessary in areas of high risk; they are usually started a week before travel and continued for 4 weeks after your return. Anti-malarial drugs generally have no effect on your IBD, but check with your doctor whether they can be taken together with your current medication.

For any person developing a gastrointestinal infection while away, the treatment recommendations are the same as for people without IBD. For trips of less than 7–10 days, norfloxacillin 400mg daily can be used as prevention, otherwise take the full dose of ciprofloxacillin 500 mg twice a day for at least 5 days, or norfloxacillin 400mg two times a day for at least 5 days, if symptoms develop.

Logistics                                                                                            back to top

Plan your journey and be in control – doing some research before you depart will pay off during your travels. In the UK the FCO provides essential information through their “Know Before You Go” campaign with links to advice from other governments: www.fco.gov.uk.

It is a good idea to have the details of your healthcare practitioner(s) with you, including phone numbers and email addresses. In case you should need medical assistance while you’re away, take a translation of the report/letter you can get from your healthcare practitioner in the language of your destination to show the doctor abroad. EFCCA has produced a medical passport for documenting your details, you can get a copy from: www.efcca.org/medical_passport.htm.

Try to get the name and contact details beforehand of doctors in the places you’ll be visiting. This information may also be available in the national language by contacting the individual EFCCA member country associations whose contact details are at http://www.efcca.org/membership.htm.

Try and find out about local hospitals before departure or, on arrival at your destination, you should find out the local emergency number and address of the nearest hospital. If you are likely to run out of medication, or need your prescription refilled, try and find out where this can be done.

Also find out the generic name of your medication (which is the same in all countries and manufacturers), and any different (foreign) brand names, for example, azathiaprine (generic name) has several brand names including Imuran (Europe and US) and Azasan (US only). Importantly, check whether your medication is available at your destination – some medicines are not available in all countries.

When booking your trip it is advisable to arrange insurance to cover cancellation due to ill health, as you may wish to cancel your holiday at short notice if a severe flare-up occurs. Always disclose your IBD to your health insurer and check that you are covered for medical treatment abroad. Extra travel insurance will be needed to cover costs if private healthcare is necessary in countries with no healthcare agreements with your country, or with no state healthcare system (e.g. US and Canada). It is always advisable to buy this cover as such emergency healthcare costs can run into thousands of euros/dollars. If you do become ill while travelling, and need to claim on your insurance, keep receipts of all expenses incurred (e.g. taxi costs, medication, hospital bills).

Be prepared for some insurance companies to expect you to confirm with your healthcare practitioner that you are fit to travel, and for it to be more difficult to obtain insurance if you have recently had surgery, or are awaiting surgery.

Your country may also have a European Health Insurance Card (EHIC) or similar scheme. If you are a resident you can apply for a card which entitles the holder to some state-provided medical services within the country they are visiting, within the European Economic Area – although you may have to make a contribution towards the care you receive.

Always remember the more practical aspects of travelling. Keep an emergency kit with you containing extra clothing including underwear, wet wipes, pads, disposal bags and tissues. Note the location of toilets en route, and sit in aisle seats on planes, buses and trains. Wear loose comfortable clothing. Find out about bathroom facilities before checking into hotels or other accommodation – you may not want to share amenities.

There may be schemes and help for people with IBD at your destination e.g. RADAR keys in the UK which allow access to disabled toilets, or ‘Can’t Wait Cards’ which explain to staff in shops, garages, libraries etc., that there is an urgent and genuine need to use staff toilets in an emergency. Try and get a ‘Can’t Wait Card’ in the local language by searching country-specific patient organisation websites and EFCCA.

If you want to make sure that you stay in control and avoid any embarrassing situations, you may wish to consider taking anti diarrhoeals while you are travelling.