Bali Belly: Symptoms, Prevention, Treatment and When to See a Doctor

What is Bali belly, exactly?

Bali belly is a nickname, not a diagnosis. It is the local label for traveller’s diarrhoea: your gut meets bacteria it has never dealt with before and doesn’t cope. Usually the cause is common intestinal bacteria, less often a virus or a parasite.

The key thing to understand is that this is not about “dirty” or poor-quality food in the way we tend to imagine it. Locals eat exactly the same dishes and are fine, because their digestive system is used to that particular mix of bacteria. Yours simply isn’t, at least not yet.

What causes Bali belly

When you trace a case back, it almost always leads to one of these sources:

• Tap water. It isn’t for drinking, and not even for brushing your teeth, unless you are sure your accommodation filters it.
• Ice in drinks. Established restaurants and bars make it from filtered water and it is safe. At street stalls there is no such guarantee.
• Washed fruit and vegetables. Salads and pre-cut fruit are risky precisely because they get rinsed under the tap.
• Food that has been sitting out. In tropical heat, what counts is how long a dish has spent neither properly chilled nor properly hot.
• Undercooked meat and seafood.
• Your own hands. The most underrated source of all. A bottle of hand sanitiser in your pocket is the cheapest prevention there is.

How to avoid Bali belly

There is no single trick that guarantees you’ll stay well, but these habits cut the risk considerably:

• Drink bottled water and check that the seal on the bottle hasn’t been broken.
• Eat where it’s busy. High turnover means the food doesn’t sit around. An empty tourist restaurant is a bigger gamble than a packed local warung.
• Choose dishes cooked fresh and served hot over whatever has been waiting in the glass display cabinet.
• Peel your own fruit. A banana, mango or orange that you peel yourself is safe.
• Don’t experiment on day one. Give your stomach a few days to adjust before you take on the spiciest dishes.
• Wash your hands and use sanitiser before every meal.
• Brush your teeth with bottled water and keep your mouth shut in the shower. This isn’t scaremongering: it is exactly how people who are otherwise careful about food end up ill.
• Know your ice. Established venues use factory-made ice from treated water, and it’s safe. You can recognise it by its regular shape with a hole in the middle. Crushed ice of unknown origin at a roadside stall is a risk.
• During temple purification rituals such as melukat at Tirta Empul near Ubud, keep your mouth closed. The water is holy, but microbiologically it is a stream.
• Skip salads and washed fruit in cheaper places, because they are rinsed with tap water.

Bali belly treatment: what to do when it hits

Most cases clear up on their own within one to three days. In the meantime:

1. Drink as much as you can keep down. Replacing fluids and minerals is what matters most, not stopping the diarrhoea. An oral rehydration solution from a pharmacy is best, coconut water is a good second choice.
2. Eat light. Rice, bananas, dry crackers or toast, clear broth. Avoid dairy, fatty and spicy food.
3. Rest. The full-day scooter trip and the volcano sunrise hike can wait.
4. Anti-diarrhoea tablets only when you really need them. They stop the symptoms but slow down how fast the bug leaves your body. They are useful when you have a long journey ahead, not as a first step.
5. Probiotics help your gut flora recover, but they are not a cure.

Bali belly: when to see a doctor

This is the part people underestimate. Get medical help if any of the following appear:

• A fever above 38.5 °C.
• Blood or mucus in your stool.
• Vomiting that stops you from keeping fluids down. You risk dehydration, and in the tropics that becomes dangerous quickly.
• Symptoms lasting more than two to three days with no improvement.
• Severe abdominal pain.
• Diarrhoea in young children or older people, who dehydrate faster.

The tourist areas of Bali have private clinics with English-speaking staff and a decent standard of care. They are expensive, though, so don’t travel here without insurance that covers medical expenses. Your GHIC card and the NHS won’t help you in Indonesia.

How long does Bali belly last and what will a doctor do?

Symptoms usually show up on the second or third day of your stay, which tends to be exactly when you’ve planned the busiest part of your itinerary. A typical course looks like this:

• The first 12 to 24 hours are the worst, with cramps and frequent trips to the toilet.
• Within two to three days most people recover without treatment.
• A week or more is no longer a normal course and a reason to see a doctor, because a parasite or a bacterial infection that won’t clear by itself may be behind it.

At a clinic, expect a stool sample, a drip to rehydrate you if you can’t keep fluids down, and antibiotics if the results call for them. Doctors in Bali deal with this every day and know what they’re doing. The bill, however, can easily reach €100 to €200 (roughly £85 to £170) even for a straightforward visit, so without insurance covering medical costs it becomes an unnecessarily expensive experience.

Can Bali belly come back, and are there lasting effects?

Yes, you can catch it a second time, even on the same trip. Getting over one infection doesn’t make you immune, because there are many different bugs that can cause it. People who stay in Bali for longer usually build up a tolerance to the common local bacteria over time, but that takes weeks.

Most people get back to normal with no after-effects. A smaller group find their digestion stays sensitive for a few weeks after the infection has passed, with milk, fatty food and alcohol not agreeing with them. Rarely, post-infectious irritable bowel syndrome develops, with longer-term problems. If your stomach still hasn’t settled a month after you get home, tell your GP that you’ve been to the tropics, because without that information they won’t routinely test for parasites.

Bali belly tablets and what to pack from home

A small travel kit packed before you fly saves you hunting for a pharmacy when you feel at your worst:

• Oral rehydration sachets, several of them.
• Anti-diarrhoea tablets for emergencies, for example before a long transfer.
• Activated charcoal for milder symptoms.
• Probiotics.
• A thermometer, because a fever is the main thing that decides whether you need a doctor.
• Hand sanitiser.
• Any medication you take regularly, in its original packaging and with plenty in reserve.