Welcome to the Toilet Paper Diaries, a series of lessons about… poop.
Your professors are paddlers and their lectures combine their education, experiences, and professional insights, providing practical advice for whitewater enthusiasts.
These lessons cover three essential feces-focused skills: minimizing environmental impact (water management), connecting with nature (identifying wildlife through scat), and staying safe and healthy (understanding water treatment). All foster a better understanding of aquatic ecosystems where paddlers play, strategies to stay healthy on the water, and mitigating negative impacts on nature.
When navigating whitewater, water naturally gets in your mouth, nose and eyes—it’s unavoidable. On multiday missions, having to drink the element we play in becomes a sort of paradox. Understanding the basics of what’s in the water can help mitigate fecal fiascos. Professor Kyle’s lesson will include details about common waterborne illness and a rundown on how to prevent, diagnose and treat… the runs.
Meet the Professor | Kyle Smith
Meet Kyle Smith, aka “Smitty” to his friends. He’s a trauma nurse with a background in big water and expedition paddling. “I’m an adventure enthusiast with potatoes and sagebrush in my veins,” says Kyle. Nurse, kayaker, DIY’er and new dad, Kyle fell in love with moving water on the Middle Fork of the Salmon at the tender age of 16. But it wasn’t until he started guiding on California’s Kern River that he really learned to kayak.
Guiding sparked an interest in wilderness medicine and, eventually, nursing. His work as a trauma nurse accommodates a “paddling wanderlust” that has taken him all over the world, paddling (and drinking) whitewater from Chile to Nepal, India to Ecuador, East Coast USA and home to Idaho. Like most international paddlers, Kyle has plenty of gut health-related stories as souvenirs from his travels. Paired with his medical training, he’s the man to teach paddlers how to stay healthy in order to, in his words, “run the sh*t, as opposed to having to take… well, you get it.”
LESSON 1 | The Skill: Building the Best Backcountry Water Purification System
Sometimes something as small as not washing your hands can result in being evacuated from the wilderness due to dehydration. Others, it’s an ill-advised sip from what seems like a clean stream. “Hiking out of Lolo Creek after a team member’s boat got pinned, I didn’t have proper water treatment options, and grew extremely dehydrated,” says Kyle. “At one point, I knelt for a long drink from the top water column of a muddy puddle before projectile vomiting everything back up.” In hindsight, this may have been the start of Kyle’s journey to GI professor.
Whether it requires an evac or rest day, or just a lot of emergency stops, the good news is: Most GI-related issues are easily avoidable with a little knowledge and a few basic tools.
LESSON 2 | Skill Application: Gastrointestinal Care for Paddlers
Understanding potential contaminants found in water helps make appropriate decisions on water treatment and consumption. Through practice and the application of knowledge, paddlers will understand why and how to mitigate and manage waterborne illness on multiday trips and expeditions and build the best backcountry water purification system for their needs.
Microbiology and Bacteriology Basics
Microbiology is the study of tiny, living things and how they affect the world. Microbes are everywhere and are responsible for both good (that perfect dry-aged steak) and bad (gut rot from hummus left in a hot van). For our purposes, we’ll break waterborne illness into three general classifications of disease-causing microorganisms. These are—from largest to smallest—protozoa, bacteria and viruses. Very few of these microorganisms occur naturally in outdoor water and are usually introduced into the water system by human or animal feces.
Diagnosing which infection is plaguing you can be a challenge without laboratory testing, so in the backcountry we focus on prevention and treatment, which means paying attention to your surroundings and de-dirtying your water. “Most strains of infection result in the same treatment: supportive therapy,” says Smitty. “Hydrate, eat what/when you can, rest, and let your body do the work. I’m always hesitant to turn to meds because, without a stool sample analysis, you can’t be sure what bacteria/virus/fungus you’re trying to treat.”
Protozoa
Protozoa are the most common disease-causing microorganism in backcountry water. They are also the largest and easiest to remove from water through microfiltration, and the toughest to kill using chemical means. Protozoan infections typically have a long incubation period, meaning you become ill from a week to a month after drinking contaminated water. Though protozoan infections like giardia and cryptosporidium are relatively common worldwide, they can be tricky to diagnose and symptoms can be quite severe, especially if left untreated.
Bacteria
Bacteria present in fresh water results from the same contamination as protozoa: animal or human fecal contamination. If you are consuming water downstream from where wild or domestic animals are “doing their business,” you are at risk. Bacteria can cause diarrhea and fever, with some strains causing more severe symptoms like vomiting, nausea and cramps. This includes Campylobacter jejuni, a bacterium commonly associated with traveler’s diarrhea, shigella (bacillary dysentery), E. coli, salmonella, cholera and other scaries. As with protozoa, the primary concern when in the backcountry is fluid loss due to diarrhea.
Viruses
The two most common waterborne viruses in North America are rotavirus and norovirus. These types of viruses are responsible for what we call “food sickness” and occur on rivers contaminated with feces or raw sewage, including your own.
Other Water Contaminants
Other human-sourced contaminants in water can give you trouble, especially when paddling in countries with less developed sewage infrastructure. Chemical contamination should be considered if you are downstream from agricultural or industrial areas. Activated charcoal, present in many backcountry water filters, will remove organic chemicals from water, but does not remove most metals, salts, or carbonates.
Avoiding mineral contamination is simple. Don’t drink water from a hot spring and don’t use water from pools that lack vegetation around them, have unnatural color, or strong mineral, metal or salty odors or tastes. Cyanobacteria, aka blue-green algae, and the toxins it produces are very harmful if consumed. Cyanobacteria blooms generally occur in late summer or early fall in warm, slow-moving or stagnant water rich in nutrients from fertilizers or septic systems. The water will smell bad and usually (but not always) presents a bloom that can look like foam, scum or mats in any range of colors from brown to bright green, blue or red.
Tried & True Mitigation Techniques
Eliminating the chance of contracting something waterborne is impossible; whitewater paddlers can’t avoid getting splashed in the face. So, let’s mitigate. To prep river water for drinking, there are four primary options: purify it, filter it, zap it or boil it.
Purify – Water purification tablets like Aquatabs are lightweight and inexpensive. They rely on chemicals such as chlorine dioxide or iodine to kill or neutralize microorganisms. Some brands, like Katadyn’s Micropur tablets, also combat the cryptosporidium parasite. Others don’t. Purifiers also combat viruses, which are too tiny for most water filters to effectively catch, but the tablets often leave an unpleasant odor or taste in the water and they require 30 minutes to a few hours for disinfection to take place.
Filter – Hand pumps and gravity filters draw water through a series of filters to remove bacteria, protozoa and visible impurities. For large groups, a gravity filter is more efficient, but patience/planning is needed. If you’re paddling in less-developed regions, using water tablets in addition to a filter can be a good second line of defense against viruses, which are often too small to filter effectively.
Zap – “A SteriPEN that uses UV light to kill waterborne bacteria and protozoa can be an awesome addition to the kit,” says Kyle. “But remember, you need batteries and fairly clean/clear water for it to be effective.”
Boil – Some swear by this method; others use it as a last resort. “If you have the fuel, time and patience, then have at it,” says Kyle. Boiling water deactivates viruses, bacteria, protozoa and other pathogens by scrambling their DNA. But sediment and contaminants, such as heavy metals or chemicals, will remain. Water needs to boil for around 2 minutes to be good to go. For large groups or when fuel is precious, it’s not the most effective method.
Do some research beforehand, carry the tools (and know how to use them), plan ahead and be patient. The CDC has a cheat sheet that can help determine what your water purification kit should include. As a bonus, Professor Kyle has shared his tried-and-true system and encourages adaptation for your needs.
Professor Kyle’s Quick & Dirty Backcountry Water Filtration
The “Mad Scientist Smitty Setup” takes a little time, but Kyle says it’s well worth it. Tools needed: cord, handkerchief or cloth, gravity filter with bag, water storage and water purification tablets.
- Find a tree with good branches or rig up a station using paddles or a kayak standing on its stern.
- Hold a handkerchief over the top of gravity filter bag 1, then have your buddy pour river water from a pot or drybag through the fabric and into the filter bag. This will grab the big particulates and help prevent your filters from clogging.
- Hang bag 1, now full of cloudy water, high above a second empty gravity filter bag, (bag 2). Use cord to pull the first gravity filter higher up into a tree after filling it, if necessary.
- Start filtering bag 1 into bag 2, hanging below. If you’re really fancy, you can run bag 2 directly into a large dromedary bag (collapsible water bag with wide mouth and lid). “I like to use a six-liter dromedary,” says Kyle.
- To be on the super-safe side, add some Aquatabs to the filtered water. One tab per two liters (three tabs for a six-liter dromedary).
- Give the filter(s) and tabs time to do their thing. Make dinner, chill out in a hammock, drink a beer, scout the rapid downstream…
First Aid Treatment
GI illness in the backcountry can have myriad implications. “Severe dehydration and nutrition will wreck any trip and might just be the difference between having enough energy to fight out of that next hole or swim a mile-long rapid,” says Smitty.
While an IV with fluids can often help, drinking Pedialyte or similar fluids is a more efficient and effective way of rehydrating. Plus, they are way easier to pack! “Powdered Pedialyte [aka rehydration salts] might be your tether to survival.” Rehydration salts can be purchased over the counter and are formulated with a precise balance of electrolytes and glucose to rehydrate cells. The powdered form is best for backcountry use.
“The idea is to get more nutrition/hydration in than out.” This can be a slow game. “If you rush by chugging a bunch of fluids, your body might reject them,” says Professor Smitty. “Slow sips and slow pace. This might mean taking a couple of layover days.”
Of course, there are medicines to treat most of these infections. But it’s nearly impossible to get a proper diagnosis in the backcountry. Professor Smitty recommends always speaking with a physician BEFORE leaving the country or throwing any drugs in the first aid kit.
The irony of understanding how to prevent and treat dehydration while being surrounded by water isn’t a joke. “It’s best to just prevent it ahead of time if possible. And carry a Garmin InReach for when things go south. Deciding whether to hit the ‘come-get-me button’ is particular to each situation, but a simple set of questions can help:
- “Does this seem like something we can manage in the field? If not, do we have the time/energy/resources to get to definitive care, i.e. a hospital before this progresses too far?”
- “Does the issue seem to be correcting itself? Do we have the resources to let it run its course, i.e. food, shelter, etc.? Is continuing downstream the easier/safer option?”
If the answer is NO to any of these questions, Smitty strongly encourages considering evacuation options.
Lesson Homework
Prep your backcountry filtration setup and stock your first aid kit to both prevent and treat GI-related illness. “At a minimum, Aquatabs,” says Kyle. “They weigh nothing and are very good chemical treatment options. If all your filters clog, at least you still have this option.”
- Pack the tools – Water filtration system, purification tablets, and any extras like spare parts, spare filters or paracord. “Companies like MSR, Katadyn, or Platypus are more or less the same,” says Kyle. “Just get a reputable one and clean or replace the filters as necessary.”
- Pack the backup – Distribute some extra purification tabs throughout your gear and group. Stash some in the kitchen, in the first aid kit and even in your PFD in case you get separated from your boat.
- Pack the relief – Stock up on rehydration salts and chat with your doctor about any drugs to have on hand. It’s much nicer to have some sense of a plan instead of trying to figure out a complex situation in a language you may not speak.
Lesson Summary
“For me, the saying ‘You can’t fill from an empty cup’ comes to mind,” says Smitty. “If you are zapped physically or mentally, you can’t be the team-member your team deserves. They can’t lean on you when times get hard if you aren’t taking care of yourself. This is applicable on the water, during travel, and in the trauma bay.”
Having the know-how to purify water and the tools to do so properly can eliminate problems before they begin. Carrying the tools to treat an ailing paddler can bring peace of mind. But always carry ample toilet paper too, just in case.
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Additional Resources:
https://www.nrs.com/learn/treating-backcountry-water
https://www.cdc.gov/parasites/giardia/general-info.html
https://www.msrgear.com/blog/water-filter-vs-water-purifier/