• Resolve to yourself that you won't let your intestines rule your life. Yes, traveling is going to involve periods of intestinal discomfort (maybe even embarrassment), but it's going to be so much more rewarding than staying at home. You will have to negotiate with your guts (I can't do any traveling in the morning because that's my worst part of the day), but don't let them intimidate you.

• Don't travel with anyone whose ability to deal patiently with your symptoms is in question. Incidentally, I've found that my best friends and best travel partners are rarely healthy people. Even if their disease is very different from IBD, non-healthy people usually can understand what it is to be at the mercy of your body sometimes.

• Visit your doctor beforehand, and make plans together for any contingencies. Coming here, I brought not only enough of my regular medication to keep me going, but also anti-diarrheals and anti- spasmodics, steroids and instructions on when/how to use them, and cipro (was that it? hard to remember) in case of little nasties in my digestive tract--with explicit instructions on what symptoms to look for. If your doctor is not well-traveled, you might want to go to one that's recommended by a traveler's association--contact the auto club or a travel agent for suggestions.

  Also find out the status of medical facilities, medical knowledge, and general hygeine in the place. If you're going to a developing country it's a good idea to bring disposable syringes in case you need to be hospitalized. Travel stores sell medical kits that include syringes and other things that might not be sterile in some places.

  Ask the american consulate for suggestions of doctors (before you need one).

• take out traveler's medical insurance.

• Learn how to ask for the closest toilet in the language of the place. This applies to english speaking countries as well! My first day in S.A. I asked for the "restroom" to the bewildered stare of a waitress. I have had to overcome my American prudery and learn to say "toilet"!

• Before taking long car trips, contact tourist boards (or the auto association) to help plan the easiest route for you. Take into consideration the frequency of towns/service areas, local norms and conditions re: use of the great outdoors (here in the savanna, it's hard to find a tree to go behind!), and road conditions (the rougher the road, the more often i need a toilet). Belonging to the auto association is a great idea, since its benefits are international and you'll more easily get up-to-the-minute info on conditions. If you're insecure about using the language, have someone write down for you a translation of "I am ill and in need of a toilet. Please direct me to the nearest one." and carry that in your pocket to show to people if the need arises. Know how to read "ladies" and "men" and "toilet" in the language of the place and what kind of pictorial symbol is used for these.

• When touring a city, get a streetmap with landmarks, etc. on it. Keep in mind where the tourist attractions, bus depots, medical centres, malls, etc. are while you're walking around. I've gone into a number of museums and paid my entrance fee only to get to the bathroom! Remember that restaurants cannot be relied upon to have public bathrooms. I ask for the bathroom before asking for a table, just to make sure. Hotels can usually be counted on for accessible bathrooms, but depending on where you are, you might not be able to get past the security. It's always a good idea to dress nicely while touring so you will be taken for someone who is legitimately in the hotel/restaurant/office building you attack. Always keep a pocketful of tissues in case there's no toilet paper.

• When flying, keep in mind that the lines for the bathroom are worst after a meal, after the movie, and when the lights go on in the morning (on overnighters). So, if you can go at other times, do. Flight attendants can be very sympathetic and may get you to the head of a line or let you into off-limits bathrooms (like in first class). Remember that the contents of your intestines will expand when the plane descends, so keep an eye on the time and make sure to get to the bathroom before the seatbelt sign goes on. On several occasions, I've had to ask strangers to squeeze my hand as we landed (the pain in the hand distracts from the pain in the gut). The strangers have always been willing to help. (Being a young woman probably helps me there.) Don't forget to ask for an aisle seat relatively near to the bathroom.

• Make sure your airplane has a bathroom. It's dangerous to reserve on anything less than 36 seats--some of the models that used to have bathrooms have had their bathrooms taken out to fit in another seat (a certain american airline whose 5-letter name begins with a "d" stranded me in this way). So, your travel agent might not be able to tell for certain from the make of plane whether there is a bathroom. Check with the airline. Also, it may be a good idea to recheck before boarding. I once got on a one-bathroom plane to discover mid-flight that the bathroom was taped over as "out of order"--it had been like this for many flights, the crew reported. (I wrote to the airline and got a full refund for my flight!)

• Tip for women of childbearing age only: If staff of a place won't let you use their bathroom and you don't plan on seeing these people again, tell them you're pregnant and feeling ill. If the staff is female, you're in like flynn. (Of course, you may have to make up a lot of details for conversation afterward, but telling people you have a disease can make them nervous. The ends justify the means!)

• Always keep some cash in your pocket (I also keep some under the insole of my shoe, just in case). This way, you'll be able to pay entrance to places to use bathroom or be a legitimate customer at a shop with a bathroom. (Or you can bribe people to use their bathroom, if necessary.)

• Eat lightly. It's really tempting to eat a lot on vacation, but the more you eat, the more you.... I found on my recent vacation that a snack (fruit or bread) at midday and a meal in the evening were sufficient for me and really reduced my running for the bathroom. This is of course more difficult if you're traveling with someone.

  I take a lot of immodium when traveling, but for me it does not cure diarrhea, but only delays it.

• For car rides, I find that my worst problems are in the beginning of the ride, and things normalize after an hour or so. So, instead of starting out on the highway, I drive around town (where there are accessible bathrooms--sometimes just around my block several times) in order to adjust to the vibrations of the car and the anxiety of being in a car. (Saying I drive around town is misleading. I drive around from service station to mall to fast food joint...) I also take a motion sickness pill the night before I leave, since cars make me feel yucky any way. (Happily for me, i hereditarily have opposite reactions to soporific drugs, so I can take these things and drive. You might need to be more careful.)

Best,
Lynne
Johannesburg, South Africa

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