Last modified: July 9, 2019
Richard Honaker M.D.View Full Profile
Swimming this summer could leave you vulnerable to pool-borne illness. Check out our guide to protect yourself.
There is no doubt that swimming is a great way to cool off in the summer. When the mercury rises it offers a fun way to stay cool and get in some exercise as well. But this favorite summer pastime can leave your body vulnerable to illness and infection.
How Dirty is the Water?
Public swimming and bathing areas can be a great way to spend time and get exercise this summer, but they can leave your body vulnerable to bacteria.
One in five people pee in the pool on average, according to a survey conducted by the Water Quality and Health Council. This type of behavior puts you at an increased risk of recreational water illnesses.
Recreational water illnesses are caused by germs and chemicals in the water we swim in. These illnesses can be contracted not only by swallowing water, but also through breathing in the mist of or even just having contact with contaminated water.
In indoor pools and hot tubs, the chemicals can sometimes make a gas that can cause poor air quality which can also lead to recreational water illnesses.
There are 10.4 million residential and 309,000 public swimming pools in the United States and 7.3 million hot tubs in operation. It’s obvious that we all love to spend time in the water, but what are the risks?
There is a very good reason that all swimmers are asked to shower before entering a public pool. Not only are you removing dirt, debris and bacteria from your body, but you are also helping to keep poop out of the water.
Along with showering before entering a public pool or hot tub, it is also recommended to avoid swimming or soaking if you are ill. Diarrhea and swimming do not mix, says the CDC. They released a report that looked at the risk of illness because of fecal contamination in the water.
Cryptosporidium is a hardy parasite that can cause stomach cramps, diarrhea, and nausea for up to a week. Swallowing just one mouthful of water contaminated with crypto is enough to spread the infection.
While most bacteria can be killed by adding chlorine or salt to water, crypto can last up to a week even in treated water. It can also be found in freshwater lakes and streams.
The best defense against stomach upset a good offence. Do not go swimming while ill with diarrhea. Always check baby’s swim diapers often and away from the water. Shower thoroughly before swimming and avoid swallowing any water.
Public pools also need to do their part to help eliminate the spread of this parasite. Proper cleaning after an accidental elimination can help stop the spread of illness.
Prolonged periods of swimming in chlorinated pools can often leave eyes stinging, but it also may affect your lungs. The chemical reaction when chlorine mixes with sweat, urine, and hair may contribute to asthma.
Extended periods in chlorinated water can increase the chances of developing asthma. The reason for this is the exposure to chloramine byproducts, such as nitrogen trichloride, which is the result of chlorine mixed with ammonia. This combination has been shown to contribute to occupational asthma in indoor pool workers. Before you consider taking a job as a lifeguard or swim instructor this summer, you should consider the possible ramifications on your health.
A study published in the European Respiratory Journal determined that when pool workers with asthma stopped working in an indoor pool environment their asthma symptoms decreased. Some were even no longer dependent on inhalers.
This risk can also fall on children who are frequent swimmers. A Belgian study determined that children who swam frequently had some of the same proteins that have been linked to a higher risk of asthma. These proteins are also found in smokers.
One way to protect yourself is to limit the time spent in indoor aquatic facilities and concentrate on saltwater and freshwater swimming. You can also encourage cleanliness in your own pool by showering before entering and not swimming while sick.
3. Legionnaire’s Disease
You don’t need to swallow the water in the pool or hot tub to be vulnerable to disease. Breathing in the mist from an infected pool or hot tub can contribute to legionnaire’s disease.
The respiratory disease comes from breathing in harmful bacteria called Legionella which develops into a type of pneumonia called legionellosis, which is more commonly called Legionaire’s Disease.
This is actually the most frequent waterborne disease amongst humans in the United States. Each year between 8,000 and 18,000 Americans are hospitalized each year in the U.S. Often the disease is treated with antibiotics but in some cases it may be fatal.
In order to decrease your risk of contracting this respiratory disease, it is important to know if you are at an increased risk.
Risk factors for Legionnaires Disease
- Adults age 50 or older
- Those with compromised immune systems
- Individuals with chronic lung disease
Exposure to the bacteria does not mean you will necessarily become ill. The signs and symptoms for Legionaire’s disease are:
- Muscle aches and pain
- Shortness of breath
- High fever
These symptoms usually appear between two and 10 days after exposure.
4. Yeast Infections
While swimming in a pool or soaking in a hot tub does not increase your chances of a yeast infection, lying around in a wet bathing suit can.
You don’t need a vagina to get a yeast infection. Yeast infections are experienced by about 75 percent of women and even some men.
A yeast infection occurs when the vagina’s natural balance between yeast and bacteria is disrupted. That disruption can cause an overgrowth of the fungus candida albicans, which leads to an infection. While this type of fungus is not the only cause of a yeast infection, it is the most common. Other types of fungus are often more difficult to treat and may require more aggressive therapies.
Symptoms of a Yeast Infection
- Rash in and around the vagina
- Itching and burning sensation that may intensify during sex or while urinating
- Vaginal pain and soreness
- A cottage-cheese like discharge that may appear thick or watery. The discharge should not have a strong odor.
Wearing warm wet clothing for an extended period creates an ideal environment for infections to grow. Taking off these clothes right after swimming and wearing breathable underwear helps to discourage bacterial growth.
Often mistaken for acne, these small red or flesh colored bumps appear on different areas of the body. Unfortunately while many of us spend our summers soaking in a hot tub or wearing a wet bathing suit these actions can actually encourage this inflammation.
Folliculitis occurs when the hair follicle becomes inflamed. This inflammation often starts out as damage to the hair follicle. This can be caused by shaving, ingrown hairs, tight clothing, sweat and irritation to the follicle from a build up or personal care products.
Hot Tub Folliculitis
There are several different types of folliculitis. Hot tub folliculitis is caused by soaking in hot tubs, jacuzzis or spas that are not properly maintained. This type of folliculitis is also known as pseudomonas folliculitis.
Pseudomonas aeruginosa is a type of bacteria that thrives in warm wet areas. It can actually survive in chlorinated water so both the chlorine and pH levels must be maintained in any warm water you enter.
In order to better protect yourself from this type of skin inflammation:
- Do not shave or remove body hair 48 hours before soaking or swimming
- Only soak or swim in water that is properly maintained
- Take off your wet bathing suit immediately after swimming
- Shower before and after swimming or soaking
6. Athlete’s Foot
Those infected with athlete’s foot are encouraged to keep their feet dry, cool and away from public swimming areas. Despite this direction, this fungi infection is often easily spread by using public swimming areas and communal showers.
Athlete’s foot (also known as tinea pedis) is an infection of the skin and feet that is caused by several different fungi. Often found between the toes, this infection can be found on any part of the foot and often is characterized by scales and splits in the skin.
The infection is spread when direct contact is made with the infected skin or when the fungus comes into contact with damp areas and is picked up by the foot.
Those infected with athlete’s foot are encouraged to keep nails short and clean, feet cool and dry and to avoid communal pools and showers.
The best way to prevent yourself from picking up this skin infection is by wearing pool shoes or sandals to prevent your feet coming into contact with this type of fungus.
7. Swimmer’s Ear
Water remaining in the ear can lead to this often painful ear infection. Swimmer’s ear is often caused by water in the ear canal which can lead to an ideal moist environment for bacteria to grow.
This growth can lead to an infection which is often located between the eardrum and ear opening. Putting fingers or cotton swabs into your ear canal can also cause swimmer’s ear as it can damage the thin layer of skin that lines the ear canal. This damage can leave the ear more susceptible to infection.
The best way to prevent this infection is to keep the ear dry and to avoid putting any foreign objects in the ear which can create damage. After swimming, dry the outside of the ear thoroughly and tip your head to the side to encourage any internal water to drain out. This is especially important in children who have narrow ear canals that can often trap water.
You can also prevent swimmer’s ear by only swimming in clean water and well maintained pools. Pay close attention to beach closings and ask your local public swimming pool how often the water levels are tested (twice a day is ideal).
Swimmer’s ear often starts out as a minor itch or irritation in the ear, especially if the earlobe is pulled. This can often be treated easily with ear drops from your doctor. Failing to treat the infection will often cause the pain to increase dramatically.
Swimming in indoor pools cause respiratory effects that can cause DNA damage that may lead to cancer.
This information is part of a study of the effects of the byproducts of disinfections of chlorinated water.
Chlorine reacts to different substances in water such as cosmetics, bacteria and urine. These reactions are considered to be a disinfection byproduct or DBP.
The study looked at 49 healthy adults after they spent 40 minutes in the water. After testing their blood and urine levels it was found they had an increase in the biomarkers related to cancer.
Exposure to the chlorinated water was associated with a five-fold increase in one of the biomarkers related to cancer.
The authors of the study did not encourage people to stop swimming but instead called for a reduction in pool chemicals. They said there was a need for further study as only a small number of people were studied and it is unknown how well maintained the pools were in the research.
9. Molluscum Contagiosum
This viral skin infection can be found in up to 10 percent of the pediatric population and is easily spread through direct contact with infected skin and infected objects.
This infection causes flat, painless bumps that vary in size between the size of a poppy seed to the size of a pencil eraser. If scratched or injured, the infection will spread.
Although more common in children, adults can also get infected. Those with compromised immune systems are particularly susceptible. When the infection affects the genitals it is considered a sexually transmitted infection (STI).
Molluscum is often associated with swimming, but this association is hard to prove. The time between exposure and development of the bumps can vary between 2 weeks and six months. Experts at the CDC are unsure of whether the virus is able to spread in chlorinated water, or if sharing personal items such as towels and kickboards is enough to spread the infection.
Signs and Symptoms of Molluscum
- Raised flesh colored bumps
- Bumps often have a small indentation or pin mark at the top near the center
- Typically bumps are ¼ inch or smaller
- Skin can be itchy
- Bumps are often found on the face, in the armpits, on the top of the hand
- Skin may become inflamed
- Bumps can be removed by itching or scratching, but this will spread the virus
If you suspect you have molluscum it is important to contact your healthcare provider. To avoid spreading the virus unnecessarily, do not scratch the bumps or shared personal items such as a towel. Avoid sexual contact if the bumps are in the genital area.
Protecting your skin this summer will not only help you avoid a painful sunburn, but will also help to decrease your risk of skin cancer.
Skin cancer is the uncontrollable growth of abnormal skin cells. This is often caused by damage to the skin’s DNA by exposure to ultraviolet rays through sun exposure or tanning beds. This damage triggers genetic mutations and defects which cause skin cells to form tumors.
More people are diagnosed with skin cancer each year than all other types of cancer combined. One in five Americans will develop skin cancer by the age of 70.
Each burn increases your risk of skin cancer. According to the Skin Cancer Foundation the average person’s risk for melanoma (a common type of skin cancer) doubles if he or she has had more than five sunburns.
The foundation recommends using a sunscreen with an SPF 15 or higher DAILY which will reduce your risk of developing melanoma by 50 percent.
Along with wearing sunscreen with SPF daily, it is also recommended that you wear a higher SPF in the summer and reapply regularly, especially after swimming. Wearing a hat can also protect the scalp.
Connect with your healthcare professional before applying sunscreen on an infant.
Play it Safe
Spending an active summer in the great outdoors is possible, but it is important to protect yourself and your loved ones. Taking the time to ensure the water is clean, showering before and after you swim and removing wet bathing suits can go a long way in preventing many of these infections.
Unsure if you should be swimming with your skin condition? Connect with one of our doctors now.
Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.