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Iowa Swimming Pools and Spas - Recreational Water Illness

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Swimming pools, spas, lakes, or rivers are all potential sources of water recreation illness. Recreational water illnesses typically affect a person's stomach and intestines, skin, or respiratory system. If you think you have a recreational water illness that needs medical attention, contact your health care provider. Report suspected recreational water illnesses to your local health department.

How can I protect myself and others from Recreational Water Illnesses?

The Centers for Disease Control and Prevention (CDC) recommends Six Steps for Healthy Swimming. Following these healthy swimming steps will help to protect you, your family, and other swimmers from recreational water illnesses (RWIs):

Three Steps for All Swimmers

  • Don't swim when you have diarrhea. You can spread germs in the water and make other people sick.
  • Don't swallow the pool water. Avoid getting water in your mouth.
  • Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers. Germs on your body end up in the water.

Three Steps for Parents of Young Kids

  • Keep germs out of the pool: Take your kids on bathroom breaks or check diapers often. Waiting to hear "I have to go" may mean that it's too late.
  • Change diapers in a bathroom or a diaper-changing area and not at poolside. Germs can spread in and around the pool.
  • Wash your child thoroughly (especially the rear end) with soap and water before swimming. Invisible amounts of fecal matter can end up in the pool.

Stomach and Intestinal Illness

Gastrointestinal illnesses affect a person's stomach and intestines, and can cause diarrhea, nausea, or vomiting. The following gastrointestinal illnesses have been associated with recreational water activities:

Cryptosporidium (Crypto)

Crypto has become one of the most common causes of water recreation diarrhea illness in the United States. The germ is found in people's stool. It's highly resistant to chlorine disinfection and can survive in a pool for as long as ten days. Swallowing contaminated water is how people are often infected. To help stop the spread of Crypto, people with diarrhea shouldn't go swimming. Learn more at Crypto, CDC.


Giardia is another common cause of diarrhea and is found in infected people's stool. It can take about 45 minutes for this germ to be killed by chlorine disinfection in pools. You shouldn't swim if you have diarrhea and you should always avoid swallowing water while swimming. Learn more at Giardia, CDC.


Shigella causes severe diarrhea, which is often bloody. It can be spread if an infected person with diarrhea swims or plays in areas such as beaches or inadequately disinfected pools. Having hand washing stations with soap near swimming areas helps keep the water from becoming contaminated. Daycare centers shouldn't provide water play areas. Learn more at Shigellosis, CDC.

E. coli O157:H7

People have gotten an E. coli infection by swallowing lake water while swimming. Symptoms are similar to Shigella and include severe diarrhea and bloody stool. This infection can also be life-threatening and cause permanent damage to the kidneys. Swimming in inadequately disinfected pools or contaminated beaches are potential sources of infection. Learn more at E. coli, CDC.


Noroviruses are very contagious and can spread through an infected person's stool or vomit. The illness often begins suddenly and usually includes nausea, vomiting, diarrhea, and stomach cramps. Chlorine disinfection helps kill this virus in pools, but lakes and beaches can be contaminated. Avoid swallowing water while swimming to help prevent infection. Learn more at Norovirus, CDC.

Skin Irritations

Skin rashes, boils, allergic reactions to chemicals, and skin damage from the sun can occur when enjoying water recreation activities.

Hot Tub Rash - Pseudomonas dermatitis / Folliculitis

Hot Tub Rash or dermatitis is an infection that causes an itchy bumpy rash on the skin. The rash usually occurs within days of swimming in poorly maintained hot tubs or spas, but can also be spread by swimming in a contaminated pool or lake. Properly maintaining hot tubs and pools helps eliminate the germ that causes this rash. Learn more at Hot Tub Rash, CDC.

Swimmer's Itch - Cercarial dermatitis

Swimmer's itch is a rash caused by an allergic reaction to parasites that typically infect some birds and mammals. The parasites come from infected snails which live in lakes, ponds, and oceans. People are not suitable hosts for the parasite's life cycle, so after burrowing into a swimmer's skin, the parasite soon dies. Reduce your risk by not swimming in area's known to have a swimmer's itch problem or where snails are commonly found, and showering or towel drying immediately after leaving the water. More tips on reducing the risk and treating swimmer's itch are at Swimmer's Itch, CDC.

Swimmer's Ear - Otitis externa

Swimmer's ear is an infection of the outer ear canal and can affect anyone, but is most common in children. Symptoms usually start a few days after swimming and include ear pain, itchiness, redness, swelling, and pus draining from the infected ear. It can be treated with antibiotic ear drops. Swimmer's ear is caused when water stays in the ear canal for long periods of time, allowing germs to grow and infect the skin. When swimming, try to keep ears dry. If water gets in your ear, tilt your head with ear facing down and gently pull your earlobe in different directions to help the water drain out. Learn more at Swimmer's Ear, CDC.