Constipation and Diarrhea
Before beginning treatment, get to know your current pattern of daily stools (i.e. how many per day and consistency) to use as a baseline. If you have an ostomy, track the consistency and output. This will help you know if something changes with your bowel habits during or after treatment if you’re facing constipation and diarrhea.
Constipation
You are considered constipated if you pass fewer than three stools per week, having very hard stools, or if you have a blockage. When these symptoms last more than three months, it’s considered chronic. Several situations could lead to constipation:
- Blockage: Something physically prevents stool from leaving body (like a tumor)
- Dehydration: Makes stool hard and painful to pass
- Recent Colorectal Surgery: The body needs time for “normal” bowel function to return
- Medications: Some anti-nausea and vomiting medication can lead to constipation. Constipation is a common side effect of opioids used to manage pain.
- Anxiety
- Hormonal imbalances
- Age
- Poor diet lacking fiber and nutritious foods
- Lack of physical activity
Managing Constipation
Managing constipation is often a combination of lifestyle changes and medication, such as a laxative or stool softener.
Prescriptions
Opioid-induced constipation may be treated cautiously with a prescribed medication. Ask your doctor about options if you think your constipation is caused by your pain medication.
Diet and Lifestyle
Try these solutions to manage constipation with diet and lifestyle:
- Prunes and prune juice
- Exercise
- Insoluble fiber (like rice, barley, and many fruits and vegetables)
- Stay hydrated
Over the counter
To manage constipation with over-the-counter solutions, consider trying:
- Osmotic laxatives, like MiraLax®. These work by drawing water into the stool, making it softer and easier to pass.
- Stimulant laxative, like Senna. These work by stimulating the colon to contract and move stool along. These may cause discomfort and abdominal cramping.
- Stool softener, like Colace®. These soften the stool, making it easier to pass.
- Bulk-forming agents, like Metamucil®. These help “bulk up” your stool, helping your body to pass it more easily.
Your doctor may recommend an enema. Talk to your oncology team or primary care provider about manual fecal evaluation.
Diarrhea
Diarrhea is extremely common. Chronic diarrhea affects 13-50% of survivors up to 10 years after treatment.
Chemotherapy can disrupt the gastrointestinal mucosa, making it hard for the body to “bulk” stool. Radiation inflames the mucosa, causing a similar effect. Antibiotics can disrupt your gut flora, which can cause diarrhea as well. If you’re experiencing diarrhea, you’re not alone.
Signs and symptoms that you’re struggling with diarrhea include:
- 7+ loose or watery stools a day
- Abdominal cramping
- Nausea and vomiting
- Dehydration
- Feeling weak or dizzy upon standing
While most people have experienced diarrhea at some point or another, cancer patients need to pay close attention to this side effect and take it seriously.
Call the doctor if you experience any of the following:
- Abdominal cramping
- Diarrhea gets worse or doesn’t improve after two days
- Diarrhea that doesn’t respond to intervention, such as over-the-counter medication
- Dehydration
- Diarrhea every hour
- Fever of 100.5 °F
- Black, bloody, or bright red stool
Managing Diarrhea
To manage and curb diarrhea, adjust your diet and use over-the-counter or prescription medications.
Over the counter
Try these over-the-counter anti-diarrhea solutions:
- Imodium® (loperamide) or other anti-diarrheal medications. This option can be purchased as liquid or pills of varying sizes and dosages. Ask your doctor about dosage and how many pills you can take in one setting, as you may need to take a higher dosage than what’s printed on the bottle for this to have an impact.
- Fiber supplement like Metamucil® (talk to your doctor first)
- Probiotics
Prescription
Your doctor may be able to prescribe anti-diarrheals:
- Sandostatin® (octreotide)
- Diphenoxylate-atropine (Lomotil)
You could also talk to a registered dietician (RD) or a board-certified specialist in oncology to discover solutions for diarrhea.
Diet and lifestyle
Diarrhea can be impacted by your dietary choices. Here are some tips that may help slow down your stools, or replace lost fluids.
- Choose beverages with sodium and potassium, such as sports drinks, to replace lost minerals
- Tell your RD if you’re taking herbs or dietary supplements (some cause diarrhea)
- Sip warm liquids slowly throughout the day
- Eat small meals and snacks regularly to avoid giving your digestive tract too much food at once
- Snack on dry, salty foods like saltine crackers or dry toast
- Eat well-cooked, peeled fruits and vegetables. You can add them to soups or smoothies to break down insoluble fiber for easy digestion
- Eat plain yogurt with live active cultures – avoid other dairy products
- Eat more soluble fiber, like oatmeal or oat bran, bananas, and applesauce (avoid beans – they can worsen symptoms)
- Keep the acronym BRAT in mind when thinking of foods to manage your diarrhea: Bananas, Rice, Apple Sauce, Toast
Foods to avoid while you’re having diarrhea:
- Hard-to-digest foods like popcorn, corn, raw vegetables
- “Gassy” vegetables (broccoli, cauliflower, cabbage, Brussels sprouts, leeks, etc.)
- Spicy foods
- Greasy and fried foods
- Alcohol
- Caffeine
- Carbonated beverages
- Sugary foods and drinks
Note: Any food with a lot of flavor, cream, and grease will trigger diarrhea symptoms.
Movement while you have diarrhea:
Exercise is almost always recommended, except when you have diarrhea. Movement may actually trigger your need to use the restroom and cause more loose stools. Move slowly and remember that it’s OK to be stationary when you’re suffering from diarrhea. Adjust your diet and try over-the-counter meds and/or prescription meds to slow down your stools so you can resume physical activity.