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Middlesex-London Health Unit

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Recreational Water Illnesses and Injuries

Recreational water may be used for exercise, relaxation, pleasure or therapy. Some examples of recreational water are pools, spas (hot tubs), water parks, beaches, lakes, rivers and oceans. Recreational water illnesses (RWIs), injuries and deaths can happen if the water or air creates an unhealthy or unsafe environment.


You or someone in your family could get a recreational water illness while playing in or being around recreational water that is polluted with germs or chemicals. Three ways that water-borne germs (bacteria, viruses, or parasites) and/or chemicals can enter the human body are:1

  • Direct contact of water with your skin
  • Swallowing water, or
  • Breathing in water droplets or mists in the air.

It is important that recreational water facilities are kept clean and safe. Everyone, from the recreational water user, to the owner/operator of the facility, to government agencies, has a role to play.



What are Recreational Water Illnesses (RWIs)?

Recreational water illnesses include a number illnesses and the health effects can range from minor symptoms to serious illness. If a person comes in contact with untreated or dirty water, they may develop skin, ear, or eye infections or irritations.1 If someone drinks contaminated water, they may get stomach or intestinal illnesses. Diarrhea is the most common recreational water illness.1 Even well kept and treated recreational water could lead to illness if the chlorine or bromine chemicals are not given enough time to kill the germs that are brought in by bathers, animals, dirt or anything else that enters the water.

Common bacteria, viruses, and parasites that cause recreational water illnesses include:

More information about these causes of recreational water illness is available on the website, an online source for credible health information and the official website of the Centers for Disease Control and Prevention (CDC).

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What are common injuries related to recreational water?

Recreational water injuries can be caused by a number of things in and around the water. Some possible injuries caused by unsafe conditions include:

  • Cuts and scrapes from falling over trip hazards on the deck of a pool or spa (hot tub).
  • Pinched skin, sprains or strains, or broken bones due to dangers such as missing, broken or loose water outlet covers (e.g. main drain covers).
  • Disembowelment (the removal of the intestines and bowels) due to suction created by sitting on a suction outlet cover (e.g. main drain covers).
  • Overheating due to high water temperatures in a spa (hot tub).
  • Head and spinal injuries from diving into shallow water.

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How can deaths from drowning be prevented?

The Lifesaving Society’s Canadian Drowning Report, 2019 Edition (PDF 4MB) shows that recreational activities were responsible for 58% of the drowning deaths between 2012 and 2016.2 Among specific recreational activities, swimming is still the activity during which the largest number of drownings occur.2

In Ontario, the Office of the Chief Coroner has created guidelines for public pools, called admission standards, to help reduce the number of young children that drown each year. Admission Standards for Class A Public Pools (PDF 140KB) were created to help lifeguards and assistant lifeguards make sure there is enough supervision of young bathers in the pool and surrounding area.

As private pools accounted for the majority of pool-related drowning deaths, especially in children and seniors,2 it is important to remember that drowning can also happen in home pools. Read the Protect Your Family by the Pool brochure (PDF 1.4MB)3 and/or view the Health Unit's Drowning Prevention video to see how you can keep your family and friends safe:4. For more information about drowning, visit the World Health Organization.

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How can my family and I stay safe in recreational waters?

Water safety is everyone’s responsibility.  The following are some water safety tips to help you and your family stay safe in and around recreational water:

Children / Weak Swimmers

  • Supervise children in and around the pool or other types of recreational water.
  • Keep young children within sight and arms’ reach.
  • Make sure young children and weak swimmers wear personal flotation devices (e.g. lifejackets) at all times.

General Safety

  • Take swimming lessons and learn first aid.
  • Pay attention to any signs posted as they will have important information.
  • Know where the nearest telephone and emergency equipment is located in case help is needed.
  • Only enter recreational water if the water is clear (e.g. you can see the bottom of the pool, spa, etc.). Water clarity is important so that possible dangers or someone who is in trouble or drowning can be seen.
  • Do not bring a glass container into the water or into the surrounding areas (e.g. on the deck).
  • Do not dive, or if you do avoid deep or long dives.
  • Do not take part in boisterous (rough and noisy) play in or near the water.
  • Do not play or swim near drains or suction devices. Your body, body parts, hair, jewelry and other objects may become trapped and cause injury or drowning. People with long hair should be very careful.
  • Do not enter or stay in a hot tub if a drain cover or suction fitting is loose, broken or missing. Let the operator of the water facility know immediately.

Health / Hygiene

  • Do not pollute the water (fecal contamination, blowing nose, run-off from the land).
  • Try not to swallow recreational water.
  • Practice good hygiene (e.g. shower before entering and re-entering the water, wash your hands after using the washroom).
  • Do not change diapers by the water because the water or objects around the water can become soiled with feces.
  • Do not go in the water if you have an open sore or infection, or if you are experiencing nausea, vomiting or diarrhea. Some germs like Cryptosporidium can survive outside of the body for long periods of time and are very tolerant to chlorine disinfection.5
  • Pregnant women and persons with known health or medical conditions should talk to a doctor before using a spa (hot tub).
Please note: This list does not include all the precautions that should be taken to stay safe. Listen to lifeguards and obey signs when you use recreational waters.

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Additional Information

To speak to a Public Health Inspector on the Environmental Health Team about recreational water illnesses or injuries, please call: 

  • 519-663-5317
Date of creation: December 19, 2012
Last modified on: February 7, 2022


1Centers for Disease Control and Prevention. (2020, June 4). Recreational water illnesses. Retrieved from
2Lifesaving Society. (2019). Canadian drowning report: 2019 edition. Retrieved from
3Middlesex-London Health Unit. (2012). Protect your family by the pool [Brochure]. London, Ontario: Middlesex-London Health Unit.
4Middlesex-London Health Unit. [mlhealthunit]. (2012, May 25). Drowning prevention [Video file]. Retrieved from
5Centers for Disease Control and Prevention. (2019, July 1). Parasites - Cryptosporidium (also known as Crypto). Retrieved from