Tips for smooth summer travels with IBD, by air, land or sea

Last month's column already covered some key supplies for making travel more comfortable for people with IBD. But there are of course other travel variables that affect IBD. Sometimes you need to consider whether driving to Miami will be easier on you than the flight there. Maybe you can’t afford any means other than a bus, or maybe you prefer passenger rail because you can spring for a car with a private bathroom. 

There are different IBD best practices for each mode of travel, but no one thing works for everyone. It can be easy to become exhausted with the whole idea of doing anything but just staying home. And sometimes, for some people, that is the right decision. But the benefits of taking time off are sometimes worth fighting for. And we're already used to normal things being at least twice as hard for us. Onward.

[Note: This column is focused on U.S. domestic travel, not international travel. International travel usually requires much more planning, including a consult with your GI and primary care doctors, and possibly also a travel medicine clinic. Modes of transport are also often very different overseas than in the U.S. For health-related info on international travel (but not medical advice), see CDC’s Travelers Health website.]

Tips for your chosen mode of transit

Car: The biggest upsides: You’re (technically) in control of restroom breaks, and you’ve usually got more room for supplies. Go grocery shopping before the trip and pack a big cooler of snacks, meals and drinks so you don’t have to rely on the interstate-exit options.

Depending on your diet, you may or may not be able to find foods you can eat at interstate exit fast food places (can you eat raw salads? Grilled chicken? Baked potatoes? Which restaurants go OK for you usually?). Research menu ingredients online ahead of time.

Yes, this sucks, and will probably be the lowlight of your week. But it’s clear that things are desperate at this point, and at least you didn’t crap your pants.

Rest stops are handily located right alongside the interstate, but they’re very few and far between -- more suited to routine urination than emergency defecation -- and are often gross. Fast food chains and gas stations are the norm. Large, national-brand gas stations or mom-and-pop tourist stops (if you happen to be in South Georgia, check out Stripling’s! As they say, "you never sausage a place.") often have more snack options and clean, well-stocked restrooms. Midrange or fancier hotels are also a good option, and you won’t seem out of the ordinary walking into the lobby to find the restroom. If you find a national fast-food chain that reliably has great restrooms, please let me know.

Let’s say you’ve got a serious urge to go and there’s nothing but highway and median in sight. What do you do? Depending on location and preparation, you might have several options:

·      Pull over and use your open car doors on one side of a 4-door car as a squatting restroom stall: Yes, this sucks, and will probably be the lowlight of your week. And hopefully no Good Samaritan pulls over and offers to help you. But it's clear things are desperate at this point, and at least you didn't crap your pants. Open both doors on one side of your car and brace yourself against the door while you squat and relieve yourself. You could also use this as a makeshift “stall” for using the option below.

·      This was covered last month: Use a bucket, special toilet seat lid and trash bag as a portable toilet.

RV or houseboat: With your own toilet, refrigerator and stovetop, you’re probably all set. I will add, though, that some of these moving homes have electric or otherwise eccentric toilets that can act up on you, and the tanks need to be emptied or maintained in special ways, so make sure you know how to troubleshoot this before you hit the road. I am aware you’re unlikely to use a houseboat as transport to a vacation destination.

Cruise ship: I’ve never taken a cruise, as my husband refuses to consider cruise ships a legitimate form of travel. And with so many reports of gastrointestinal illnesses aboard these ships, I’ve come to agree it isn’t for me. But on certain ships in certain cruise companies, I’ve heard it’s much less of an issue. To find health reports for the specific boat you’d be on, go to this CDC site. And for general tips for staying healthy on cruise ships, visit this CDC site.

Can flight attendants really get you in trouble somehow for using the restroom when the seatbelt sign is lit? 

Airplane: You can get really dehydrated on flights, which is bad for your gut as well as the risk of blood clots (which people with IBD can have a higher risk for). So drink tons of water every chance you get (I ask for two drinks from the flight attendant each time, one water and one juice, since they’re “fun-sized.”), and buy one of those extra-tall bottles of water from the airport newsstand to take onboard. Staying hydrated and walking around are helpful in preventing both blood clots and constipation. 

Also, the airport food court usually has a slightly greater variety of food options than the plane food cart will, so buy some easy-to-pack snacks or meals to stuff into your carry-on. And you don’t need me to tell you this, but get an aisle or bulkhead seat for leg-stretching and quick escapes to the bathroom.

Speaking of: Can flight attendants really get you in trouble somehow for using the restroom when the seatbelt sign is lit? The answer seems to be no, but I haven't found a definitive answer. For a humorous adults-only NSFW enactment from Key and Peele, click here.

Passenger rail: You won’t be thrilled with the bathrooms on Amtrak, if you’re using the public ones (if you have a private one in a sleeper cabin, it may be a different story for you, Moneybags). The train is frequently in forward motion, but there’s also side-to-side jostling and you’ll even catch air sometimes. As you might imagine, this makes aiming one’s urine stream especially challenging. Bring flip flops or rubber-soled slippers for midnight trips to the bathroom; you don’t want stranger-pee-soaked sock feet. 

Bring slippers for midnight trips to the bathroom; you don’t want stranger-pee-soaked sock feet.

Their food may have changed since I last rode 5 years ago, but we chose between a quick-service cart of cold sandwichy, chipsy stuff, or full-service dining. The sit-down dining food was better than I thought it would be, but you do have to sit with strangers, which we hated the idea of but ended up embracing because our companion was a cute, old-man guardian angel who asked to take our photo and prayed for our future marriage. But that’s probably the best-case scenario possible, besides maybe an NPR reporter on assignment or a thrifty HR recruiter for Google.

Keep in mind what sleep disturbances can do to your gut; while you have footrests and a good bit more room than on a plane to stretch out, you’re also usually there a lot longer, and there are a lot more disturbances (people getting on and off the train rarely keep a respectful hush to their voices). There are quiet cars, apparently, but we were new and too overwhelmed to ask (the boarding, luggage and family sendoffs are very different from at the airport!). Also, the train was kept hospital-cold, so dress warmly or buy supplies from Amtrak. 

Bus: My only experience with this was cushy charter buses for field trips as a kid. Some buses have bathrooms and some don’t; I imagine they can have the same issues as Amtrak shared bathrooms. You can usually take more luggage onboard a bus (true for Amtrak, too) than on a flight, and it’s of course a lot cheaper than flying (or buying a car and paying for insurance and gas) too.

Have experience traveling by bus with IBD? Ever been citizen's-arrested by a flight attendant? Have you actually tried the bucket toilet?! Please comment below.