Traveling while living with a health condition is an issue for many people. The intensity of the issue can increase with the severity of the illness. Most travelers with minor health concerns prefer to wait until they are healed and reschedule their travel plans accordingly. So, what does a person do if the ailment will not go away entirely or subside in a reasonable timeframe? Is traveling no longer in the cards for these folks? Do they have to give up their dreams of a Hawaiian holiday, European adventure, work trip, or quality time with family and friends?
The answer in a word is ‘No’.
People with Crohn’s Disease or Ulcerative Colitis, the two main forms of Inflammatory Bowel Disease (IBD), will likely identify with all of the above. Almost any change in their routine, whether food, water or climate, can trigger a flare. This leads to an upset digestive system, and not so rarely, an embarrassing outcome.
The unpredictability of this chronic disease, which can cause severe abdominal pain, diarrhea and cramps, can make even a simple trip worrisome. Nevertheless, a large number of people who are afflicted with IBD do travel, not just within the country, but also extended trips abroad. While you may find the thought of traveling with IBD daunting, it is manageable with foresight and planning.
Plan Well
Thoughtful planning is the key to a comfortable outing. With careful preparation before each trip, it is possible for IBD patients to travel without any or minimal discomfort. Just as a healthy person would prepare before a successful journey, IBD patients need to address other considerations and take extra precautions when making travel plans.
At the top of the list is a discussion with your doctor apprising them of your entire travel plan. This includes the duration, all modes of travel (plane, car, train, cruise ship, bicycle and hiking), and destination. All of these are necessary to ensure your trip is comfortable for the entire duration. Professional medical advice will equip you with an emergency plan to manage flare-ups in any situation. You can have confidence in caring for yourself when you know what to do if your IBD symptoms flare-up while away.
Studies have shown that stress and anxiety can trigger a flare-up or increase the severity of IBD. So, it’s best to be fully prepared.
Travel Challenges
In addition to equipping yourself with professional medical advice, there are other equally important issues to address before embarking on your journey.
The location and availability of a restroom is one of the most critical concerns IBD patients have when traveling. Carrying a Restroom Access Card is a necessity for IBD travelers. The Restroom Access Act, known as Ally’s Law, was passed in the U.S. to address this medical need. This act has put into practice in a large and growing number of states. It requires retail businesses with employee toilets to provide access to people with these medical conditions when needed.
Members of the Crohn’s and Colitis Foundation can get the Restroom Access Card, printed or in mobile form. It helps you discreetly ask for immediate access to restricted bathrooms when you have symptoms. Eligibility is restricted to patients diagnosed with Crohn’s disease and ulcerative colitis.
You can locate restrooms along your route if you are travelling by car or foot. Find out in advance if the train or bus you will be on has a toilet facility. For travel by plane, you can inform the flight attendant you have IBD and request a seat near the bathroom. You can also request healthy meals that match to your dietary requirements ahead of time.
There are a number of mobile apps that can help you locate a bathroom no matter where you are. The most popular free apps are Toilet Finder, Flush and SitorSquat. You can download them anytime on your smartphone or pad. These apps use the location of your mobile device to map out nearby toilets in thousands of places around the world. Some apps will also filter restrooms by select features, such as handicap accessible or having a changing table.
Medication
Your doctor will recommend medications to pack, an emergency medical kit to bring with you, a recommended diet to maintain while traveling including foods to avoid, and if necessary, vaccinations to get before you leave.
Know that medications you are taking may or may not be available at your destination. While packing your medications, always aim to take enough for your entire trip plus extra in case of unforeseen travel delays. Keep the medications in their original packaging to ensure recognition if needed. If you will be away for a considerable period of time, you may need to check with the pharmaceutical company whether your medication is available in the countries you plan to visit and the local name, if different. It also helps to carry a list of medications you might need with their generic names, as brand names may be different in other countries. If your medications cannot be obtained where you are going, then you can ask your doctor for an additional prescription and purchase extra supplies.
Many medicines need to be refrigerated. If this is the case for your medication, then arrange to store it in a small cooler bag. This is generally available from drug stores.
In case of an emergency when flying or your luggage is lost or delayed, it is important to carry medications in your hand luggage. However, hand luggage restrictions may require that you show a letter from your doctor stating your medical need. Also, you may need to check with the airline before you fly for other rules or restrictions that may affect traveling with your medication.
Medical Documents
We recommend always carrying a letter from your doctor with a description of your health condition, list of prescriptions, and stating that you are fit to travel. The letter could also contain your health history, allergies, and plan for a flare-up if one should happen. It is important to have this letter translated into the language of your destination, especially if English is not commonly understood.
Also, be sure to carry your doctor’s contact information for referral in case of an emergency.
Insurance
Always carry your health insurance information, and be sure to check before your trip if your health insurance has universal coverage – meaning will it be accepted throughout your travel. If it is applicable only locally or within the U.S., you might consider purchasing additional travel medical insurance. You need to report your IBD to the insurance company when purchasing a policy. If you do not, you may find that your insurance is not valid or you may have problems when filing a claim. Please note that some insurance companies do not cover pre-existing conditions.
Destination precautions
To avoid a flare-up, we recommend taking precautions on arrival.
- Continually sanitize your hands.
- Depending on the location, you might restrict your diet to hot and cold foods. Food stored at room temperature can increase the risk of bacterial infections.
- When you plan to eat out, choose a restaurant which has more customer traffic, which means their food is generally fresh.
- Learn how to ask for restroom facilities and where they are located.
- Drink plenty of healthy fluids. Body fluids lost due to dehydration need to be replaced, especially on planes and in hot weather. Carbonated drinks and citrus juices can aggravate diarrhea, so they are best avoided.
- If the water quality is questionable, boil the water first or drink distilled water. Bottled spring water or purified water may be better than the tap water served in many restaurants.
- If appropriate, identify a local physician in your destination who could treat your condition. Ask your doctor for a recommendation or check the Crohn’s and Colitis Foundation website.
- While planning your travel, also consider the season and expected weather in your travel destination. A correlation between seasonality and exacerbations of IBD is not fully established. However, some studies have shown that a significant percentage of patients experience more symptoms during autumn than other seasons.
- Heat waves increase the risk of IBD flares. Extended heat can alter bacterial growth and put stress on the body. A study found that IBD flare-up risks increase 4.6% every day during a heatwave.
- Cold weather may be an issue for people who suffer from IBD and arthritis. Stiff and aching joints can put a damper on travel to destinations with low temperatures.
Avoid Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis, or blood clots, are a risk for anyone taking a long journey by plane, train or car. Individuals with IBD face increased risk of blood clots while sitting for long periods, especially if they have had recent surgery.
Risks can be reduced by taking these precautions:
- Wear loose-fitting, comfortable clothing. Natural fibers are breathable and healthier for the skin.
- Stay hydrated and avoid alcoholic and caffeinated drinks both before and during the journey.
- Avoid smoking.
- Regularly flex your calf muscles and rotate your ankles while sitting.
- Take multiple deep breaths at regular intervals to alleviate stress, anxiety and emotions.
- At regular intervals, walk around the plane cabin, aisle is trains, or during bus and car stops.
- Wear travel compression socks or stockings to avoid blood clots.
Travel kit
All IBD patients should prepare and carry with them a travel kit that includes wet wipes, extra underwear and a change of clothes. Studies have shown that people with IBD have an increased risk of a flare-up within a month of traveling due to changes in air pressure and other external conditions mentioned above. This makes it important to have a travel kit ready at all times.
Having IBD should not take away from the joy of travel. With the right preparation and planning, you can easily explore new places and enjoy spending time away with others.
