Diarrhea is the passage of loose or watery stools three or more times a day that may or may not cause pain or discomfort in the abdomen (belly) and/or rectum. Diarrhea can cause problems like dehydration, loss of important nutrients, weight loss, and fatigue. It should never be ignored or left untreated.
What causes diarrhea?
- Diseases of the bowel.
- Some chemotherapy agents, as well as radiation therapy and surgery involving the bowel.
- Certain medications.
- Bowel infections.
- Certain foods and nutritional supplement drinks.
What can I do to prevent or lessen diarrhea?
There are many changes you can make to your diet to help lessen diarrhea. These include:
- Eat bland and easy to digest foods such as chicken, fish, eggs, puddings, mashed potatoes, noodles, rice, yogurt, cottage cheese, cream of wheat, farina, smooth peanut butter, white bread, bananas, applesauce, canned fruit, and well-cooked vegetables.
- Avoid dried fruits, cruciferous vegetables (broccoli, cauliflower, cabbage, peas), raw vegetables, whole grains, beans, and legumes.
- Soluble fiber is a type of fiber found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include:
- Fruits: Applesauce, bananas (ripe), canned fruit, orange, and grapefruit.
- Vegetables: Boiled potatoes.
- Breads & pastas: White rice and products made with white flour.
- Cereals: Oatmeal, cream of rice, cream of wheat and farina.
- Eat small amounts of food 5-6 times throughout the day, instead of three large meals.
- Add nutmeg to foods in order to slow down the movement of material through the intestines.
- Drink 6-8 glasses of uncaffeinated fluid per day. Besides water, consider fluids that replace minerals and electrolytes lost through diarrhea such as sports drinks (Gatorade®) or broth.
- Clear liquids may be easier to tolerate. Try clear fruit juices like apple or cranberry, ginger ale and jell-O.
- Avoid caffeine (cola, coffee, tea), alcohol, milk or milk products, chocolate, dried fruits, beans or popcorn as well as fatty, fried, greasy or spicy foods.
- Avoid very hot and cold beverages.
It may help to keep a food diary to help figure out which foods make diarrhea better or worse for you.
Care of the rectal area:
- Clean the external rectal area well after each bowel movement. Use warm water and soap, and pat dry with a soft towel. This will help to prevent anal burning.
- Inspect the rectal area daily for red, scaly or broken skin. Report this to your care team.
- Soak in a warm bath or use a sitz bath, which delivers a continuous, gentle flow of warm water over the rectal area while sitting on the toilet. Sitz baths can be purchased at your local drug store.
- Water-repellent creams, available over-the-counter at your drug store, such as A & D ointment, are very effective to protect the skin. Ask your doctor about a numbing ointment if the area becomes very sore.
Can I take over-the-counter medications?
You should not take any over-the-counter medications while receiving chemotherapy without talking to your provider first. This includes all over-the-counter anti-diarrheal medications, such as Kaopectate®, Immodium AD®, and Pepto-Bismol®. This is because diarrhea can be caused by an infection or due to a medication you are receiving. Your healthcare team will want to test your stool before you take any medication to stop the diarrhea. If your provider decides that it is ok to take these medications they may give you instructions that are different from those on the package.
When should I call my provider?
Diarrhea should not be ignored since it can result in dehydration and can be uncomfortable. Call your provider right away if you have any one or more of the following:
- 6 or more loose bowel movements per day for more than 2 days in a row.
- Blood in or around the anal area, in the stool, on the toilet paper or in the toilet bowl.
- Less urine output than normal.
- Inability to drink liquids for more than 24 hours.
- Fever over 100.4°F (38°C).
- Weight loss of 5 pounds or more since the diarrhea started.
- Swollen and/or painful abdomen (belly).
Diarrhea can often be well managed through the use of medications and by changes to your diet. Make sure you talk to your provider if you are experiencing any changes to your bowel habits including diarrhea.