Kelum Pelpola
HEALTHY SWIM: Next time you may have to think twice before you leap into the swimming pool. The reason for this is that a new entity named recreational water illnesses (RWI) has been described.
RWI refers to any illness or infection caused by organisms that contaminate water in pools, lakes, and oceans, resulting in diarrhoea, skin rashes, swimmer’s ear and other conditions. And they are on the rise.
The rate has more than doubled in the past 10 years, according to data from the CDC(Centre for Disease Control in the USA).
However, there is definite good news. It’s that some simple precautions would help you keep these illnesses at bay. Even though you get the disease, by being alert, quick treatment could be taken and complications could be very easily avoided.

What are the organisms causing RWIs?
Infection-producing germs that can lurk in water include Pseudomonas aeruginosa, a bacterium which causes swimmer’s ear (an infection of the outer ear canal, known medically as otitis externa) and skin rash (dermatitis).
Meanwhile, organisms such as cryptosporidium, Giardia lamblia and bacteria such as Shigella, and E. coli can cause diarrhoea.
Although respiratory illnesses and colds could be transmitted through swimming pools or lakes, by far, skin rashes, swimmer’s ear and gastrointestinal problems are the most common.
How do we get these illnesses?
Diarrhoea may occur when contaminated water is swallowed and driven into the mouth or nose. It may not begin immediately after a swim; sometimes it comes on one to two weeks later.
Swimmer’s ear is easier to get. Excessive water in the ear canal breaks down the protective barriers in the ear and allows bacteria to get into the ear.
It is marked by one to two days of progressive ear pain that is worsened by chewing or when the ear is being pulled. Itching, pus and discharge often follow.
Swimmer’s itch, also called cercarial dermatitis, is marked by tingling, burning, or itching of the skin, small reddish pimples, and/or small blisters that appear within minutes to days after swimming in contaminated water.
This skin rash is primarily caused by exposure to parasites or their larvae in fresh and salt water.
How can they be prevented?
Many people say that adding chlorine to a pool can kill all potentially disease-causing germs, and that’s true, to a degree.
Chlorine in properly disinfected pools kills most germs that can cause RWIs in less than an hour, but it takes longer to kill some germs, such as cryptosporidium, which can survive for days in even a properly disinfected pool.
The best way to prevent diarrhoea is not to swallow water. Also, don’t swim when you have diarrhoea because you can spread germs in the water and make other people sick. Take a shower before swimming and wash your hands after using the toilet, because germs on your body end up in the water.
Swimmer’s ear may be prevented by drying ears thoroughly by tilting your head to the side and tugging the ear lobe to let the water out after swimming. Getting ear plugs, or wearing swim caps pulled over your ears also may help.
Showering before and after taking a dip in lakes, ponds and oceans can help with prevention of skin rashes.
The above mentioned precautions definitely help to keep the RWIs at bay, but it’s important to be on the alert.
If you have diarrhoea one to two weeks after swimming, drink plenty of fluids to prevent dehydration. Antidiarrhoeal medicine may help, but talk to your doctor before taking it.
As for swimmer’s ear, new treatment guidelines suggest that antibiotic ear drops are the treatment of choice for swimmer’s ear, but always consult your doctor before starting treatment. For pain, oral medication can be given immediately.
Most cases of swimmer’s itch do not require medical attention, but not scratching and using anti-itch cream can help. Get advice from your doctor regarding such creams.
Anyway, the take home message is this. Swimming is a very good exercise which relaxes both mind and body. It’s good for both adults and children.
However, these conditions which may be associated with swimming in swimming pools, lakes or sea could be easily prevented by taking the above precautions. Don’t let these diseases ruin your precious swim.
The writer is a Final Year Medical Student Faculty of Medicine, Colombo.