Bali Belly: Avoiding It, Treating It & Mythbusting

Falling ill can make or break your trip, so it's no surprise that one of the most common topics people ask us about is Bali belly.

Nobody wants to forego coconuts on the beach for a mad dash to the toilet. And if you're a foodie like us, avoiding the delicious local cuisine isn't an option either.

So if frequent bathroom trips aren't on your Bali bucket list, you've come to the right place. In this guide, we'll share some prevention methods, practical tips to minimise your chances of getting Bali belly, and our recommended treatments in case you do.

What is Bali Belly?

Bali belly is the colloquial name given to travellers' diarrhoea in Bali (or gastrointestinal infection in medical terms).

You may have heard the terms Delhi belly, Bangkok belly, Montezuma's revenge (Mexico), the Kathmandu quickstep (Nepal), or the Rangoon runs (Myanmar). These are all nicknames for travellers' diarrhoea.

At home, you’d simply call it food poisoning, gastro, or the runs. But Bali belly sounds more exotic, right?

Bali belly comes from consuming food or drink contaminated with bacteria, viruses, or parasites that our stomachs don’t like or aren't used to.

The most common bacteria that causes Bali belly is E.coli. While there are hundreds of strains of E.coli, most of which are harmless, a type called enterotoxigenic E.coli (ETEC) is common in developing countries such as Indonesia, where the water quality is poor.

E.coli isn’t always to blame. Other bacteria such as shigella, campylobacter, or salmonella, as well as viruses and parasites, can also cause it. Regardless of what causes it, the steps for avoiding Bali belly remain the same.

Will I Get Bali Belly?

Unfortunately, Bali belly is somewhat of a rite of passage for many people in Bali.

One study found that around 60% of people said they experienced symptoms during their visit.

But anecdotally, we’ve found this to be much higher. Most people we know who’ve visited Bali have experienced at least mild symptoms, typically within the first week or so.

The good news is, it’s rarely serious and tends to pass within a day or so.

What Are the Symptoms?

The main symptom of Bali belly is diarrhoea. If you have it light, around 3-5 episodes of watery stools per day is typical. But in worse cases, this can be up to 20 episodes.

The diarrhoea is often accompanied by at least one of the following:

• Nausea

• Vomiting

• Cramps

• Urgent and explosive bowel movements

• Blood and mucus in your stool

• Fever

• Loss of appetite

How Long Does Bali Belly Last

In our experience and from talking to friends, your symptoms will usually last around 24 to 48 hours.

According to medical professionals, symptoms can persist for up to two weeks and a small number of people can develop long-term effects (more on this later).

Is Bali Belly Contagious?

Although medical professionals will tell you that Bali belly is contagious, it’s not contagious in the same way as a cold or flu.

You can’t catch Bali belly just by coming into normal contact with someone else who has it.

To pass it from person to person, you’d need to ingest bacteria from the infected person's gut.

This only happens if you come into contact with their poop or vomit and then touch your face or mouth. Provided everyone is washing their hands properly after toilet use, there’s little risk of it spreading.

Emily and I have both had Bali belly at separate times and did not pass it to each other.

Preventing Bali Belly Before You Travel

Your likelihood of getting Bali belly and the severity of the symptoms are linked to your immune system and gut health.

Here are some supplements you can take to improve your body's natural defences before you set off:

• Probiotic Supplements

Probiotics are live microorganisms that can improve your gut health. Many different types of probiotics are available, but only Saccharomyces Boulardii (S. boulardii) has been shown to effectively reduce the risk of getting Bali belly by making it difficult for harmful bacteria to take hold (source).

Typically, you should start taking them around a week before your trip (follow instructions on the pack). For ease while travelling, try to choose a brand that doesn't require refrigeration.

• HBC Supplements

Hyperimmunised Bovine Colostrum (HBC) is the milk produced by cows in the first few days after they give birth. It’s rich in antibodies that patrol your gut and bind to any bad bacteria, such as E.coli, before it has the chance to cause illness (source).

The most well-known HBC supplement for travellers is Travelan, but other brands are available.

Practical Tips To Avoid Bali Belly

1. Only drink bottled water

The tap water in Bali is not safe to drink, so you should only drink bottled or filtered water. You can buy this in the shop and many hotels will provide complimentary water refills to save on plastic waste.

If you don’t have access to bottled water, you can also boil the tap water before drinking it. But make sure you maintain a rolling boil for 1 minute to kill all germs.

We regularly use tap water for making hot drinks and cooking with no problems.

2. Avoid ingesting water when brushing your teeth and showering

When in Bali, you should also try to avoid ingesting tap water when brushing your teeth or showering.

Over time, you might build up enough resistance to start using tap water to brush your teeth (this is what we do now). But when you first arrive, or if you're not staying for long, it's best to use bottled water.

3. Be cautious of where you eat

Lots of online advice recommends avoiding certain foods such as salads, fruit, buffets, sushi, etc. While there is some underlying logic, take the advice with a pinch of salt and don’t let it ruin your trip because you can’t eat the things you like.

In reality, your chance of getting Bali belly comes down to the restaurant’s hygiene standards, not what type of food it is. A salad prepared in sanitary conditions is much better than cooked vegetables handled in a dirty kitchen.

Unfortunately, there’s no hard and fast way to determine the hygiene standard of a restaurant in Bali. You just need to use your common sense.

Remember, you can get Bali belly from anywhere, no matter how cheap or expensive the food is. You can even catch it from your high-end hotel restaurant if it’s not sanitary.

Saying that, the chances of getting Bali belly are probably greater from a side of the street warung (local restaurant) or restaurants in rural areas where they don’t regularly cater to the weaker stomachs of tourists. Look for places with other foreigners and check the reviews on Google or TripAdvisor.

4. Close your mouth during the water purification ritual

It’s not just food and drinks that can give you Bali belly. Most tourists in Bali will take part in the ‘Melukat’ water purification ceremony at temples such as Pura Tirta Empul.

Part of this ritual involves drinking a small amount of water from the natural holy springs. But the bacteria in this water can also make you sick. Simply splash the water against your mouth while keeping it firmly closed. Don’t consume it, even if a guide tells you otherwise.

5. Wash your hands before handling food

If you’re preparing food yourself or eating with your hands, make sure you've washed them thoroughly and use hand sanitiser where possible.

This is one of the simplest ways to avoid contaminating your food with harmful bacteria or viruses.

Treating Bali Belly at Home

In most cases, Bali belly will clear up by itself, and you won’t need to see a doctor. But here are some steps you can take at home to help manage your symptoms:

1. Drink plenty of water

Staying hydrated is the most important treatment for Bali belly. If you have severe diarrhoea and vomiting, you can quickly become dehydrated, which can lead to other conditions, such as acute kidney injury, and require hospitalisation. Make sure to drink plenty of water.

2. Replenish your electrolytes

Sickness and diarrhoea can also lead to an imbalance of electrolytes (ions), which are essential minerals in your body, such as sodium, potassium, magnesium, and calcium. This imbalance can cause fatigue, headaches, and dizziness.

One of the best ways to replenish your electrolytes is by drinking fresh coconuts, which are easy to find in Bali and naturally rich in electrolytes and minerals (and they’re delicious too!).

An alternative source is "Pocari Sweat", an electrolyte drink available in most pharmacies, supermarkets, and convenience stores around the island - Emily swears by this stuff when she has an upset stomach.

3. Try activated charcoal tablets

A recent discovery of ours for reducing the severity of Bali belly symptoms is Norit, a brand of activated charcoal tablets. Activated charcoal works by adsorbing toxins and gases in your gut and helping them pass out of the body rather than being reabsorbed.

Norit tablets are extremely affordable and widely available in minimarts and pharmacies all across the island. It's best to take them at the onset of your symptoms. We've found them most effective for mild cases when combined with electrolyte drinks.

4. Take loperamide (Imodium)

Imodium tablets are a widely used over-the-counter drug for treating diarrhoea. They contain loperamide, which slows down the movement of your gut. While they don’t cure Bali belly, they can temporarily help with symptoms and give you some respite from the toilet.

Immodium (or alternative brands) are readily available from pharmacies in Bali such as Guardian or Kimia Farma. Know that the pharmacies have a habit of trying to upsell you on other supplements that you might not always need.

If you're in a more rural area where English is less spoken, look for an "Apotek," which means pharmacy. Rather than describing the specific medicine you're looking for, explain that you have Bali belly and they'll know what to give you.

5. Eat bland foods

For the fastest possible recovery, it’s best to avoid consuming anything that will further irritate your gut, such as spicy foods, greasy foods, dairy, caffeine, and alcohol. High-fibre foods can also make diarrhoea worse.

Instead, eat bland foods such as plain white rice, plain crackers, bananas, and toast, all of which are available in Bali.

When and How To See a Doctor

When To See a Doctor?

If your symptoms persist for more than two days without any improvement, it’s a good idea to see a doctor.

You should also see a doctor if you experience:

• Signs of dehydration – such as excessive thirst, dry mouth, dark urine, or dizziness.
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• Severe stomach or rectal pain.
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• Blood in your stools.
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• A fever - when your body temperature is above the usual rate of 38°C (100°F), often accompanied by chills.
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• Other symptoms – rashes and joint pain are signs the infection is spreading.
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• Underlying health conditions – if you have a weakened immune system, it’s good to seek medical help sooner rather than later.

Remember, children can become dehydrated much faster than adults so be especially cautious.

How To See a Doctor in Bali?

If you’re staying in Ubud or one of the touristy resort areas in the south, finding an English-speaking doctor is very easy (and much quicker than seeing one back home!).

Just like you would when looking for a restaurant, head over to Google Maps and search for "doctor" to find a medical practice close to you and check the reviews. You should only go to a hopsital A&E if it's an immediate emergency.

I’ve personally used UbudCare who have branches in Ubud and Canggu. I turned up without an appointment and saw a doctor within 10 minutes (costing around £30).

Depending on your travel insurance, you may be able to claim this back.

What Will a Doctor Do?

Before prescribing medicine, a doctor will order a stool test to determine whether your illness was caused by bacteria, viruses, or parasites.

The turnaround time in Bali is fast, so you can often get same-day results.

Once the doctor has more information, they can prescribe the appropriate medications.

In cases where your Bali belly has been caused by bacteria (such as E.coli), antibiotics will usually be prescribed. if it's been caused by viruses or parasites, antibiotics won't help so you should always get a test first.

Are There Any Long-Term Effects?

In a very small proportion of travellers, the symptoms of Bali belly can continue for longer than 2 weeks.

This is more likely when it's been caused by a parasite (rather than bacteria or viruses) or when you have an underlying gastrointestinal disease such as coeliac disease, colorectal cancer, or inflammatory bowel disease (not the same as IBS).

Can You Get Bali Belly More Than Once?

When your body is introduced to harmful germs, it learns to create antibodies to prevent or lessen the effects of those germs in future.

But Bali belly can be caused by a whole host of bacteria, viruses, and parasites. So having antibodies against one germ doesn't necessarily help against others.

You need to spend a lot of time in Bali to be introduced to all of these germs and develop a natural immunity like the locals have.

So yes, you can get Bali belly more than once and it's not uncommon for people to get it again on the same trip.

According to estimates, anywhere between 5-30% of travellers report catching travellers' diarrhoea more than once during a trip (this data is not specific to Bali).

Regardless of whether you’ve had it or not, continue to follow all of the precautions we’ve shared in this guide for the duration of your trip.

Medical resources used in this guide:

• Diarrhea Among International Travelers in Bali, Indonesia: Clinical and Microbiological Finding (2017)

• Travel Medicine E-Book, by J.S. Keystone, et al (2012)

• Factors Related to the Incidents of Travelers’ Diarrhea in International Travelers in the Jimbaran Area (2023)

• Traveler’s Diarrhea Risk Factors on Foreign Tourists in Denpasar, Bali (2016)