People usually get cholera by eating food or drinking water that is unclean. When people have cholera, they have a lot of diarrhea, and the cholera bacteria stays alive in their feces. In developing countries, often there is not good sanitation. Cholera can spread if this diarrhea gets into water that other people use. For example, if sewage (human waste) gets into a river, people can get cholera if they: