Diarrhea

What is Diarrhea?

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 and/or rectum. Patients with cancers of the gastrointestinal tract, including the stomach, colon and rectum often experience diarrhea. In addition, diarrhea may be a side effect of cancer treatment, especially chemotherapy and radiation therapy. Other common causes of diarrhea in cancer patients include bacterial and viral infections, anxiety, and nutritional supplement drinks (such as Ensure), which contain large amounts of vitamins, minerals, sugar, and electrolytes. Patients who are constipated may also have leakage of diarrhea. Because diarrhea can cause many problems, including loss of fluid from the body (dehydration), loss of important nutrients, weight loss, and fatigue, it should never be ignored or left untreated.

What Can I Do to Prevent Diarrhea?

The following information has been provided to help you manage and control this side effect.

Stop using Reglan, stool softeners, laxatives, or fiber supplements.

Make changes in your diet.

• Eat bland, low fiber foods such as the BRAT diet (Bananas, Rice, Applesauce, and Toast) boiled white rice, cheese, boiled chicken, and mashed potatoes.
• Choose foods high in protein, calories and potassium, and easy to digest such as cottage cheese, eggs, baked potatoes, cooked cereals, bananas, macaroni and pasta, white toast, and smooth peanut butter.
• Eat small amounts of food 5-6 times throughout the day, instead of three large meals.

Foods to Avoid

• Greasy, deep-fried, fatty foods, and rich sauces because these may worsen diarrhea. Sugary or very spicy foods may also be bothersome.
• Sugar-free gums and candies usually contain sugar alcohols (sweeteners) that may cause diarrhea.
• Any foods that form gas will likely be a cause for diarrhea also. Some of these foods are: onions, beans, cabbage, peas, broccoli, cauliflower, whole grain breads and cereals, nuts, and popcorn.

Increase your fluid intake. Try to drink 3 quarts of fluid per day, unless your doctor or nurse tells you not to do so. This will help to prevent dehydration and malnutrition, which may result from diarrhea. Here are some specific suggestions:

• Do NOT drink coffee, tea, alcohol, milk or milk products, since they can make the diarrhea worse.
• Drink sports drinks, such as Gatorade, which help to replace some of the electrolytes lost in diarrhea.
• Drink clear liquids, including clear fruit juices (apple, cranberry, grape), ginger ale, and water.
• Drink liquids at room temperature.

Take over the counter anti-diarrhea medications if you are having more than 4 loose stools a day (or two more beyond what is normal for you). Imodium AD (or the generic equivalent) 2 tablets after the first loose stool, then 1 tablet after each loose stool up to 12 tablets a day until diarrhea stops.

Keep the rectal area clean and dry to avoid irritation and infection. Try using disposable washcloths (baby wipes) instead of toilet paper. Apply petroleum jelly to the rectal area (if you are undergoing radiation treatment to this area, then follow the radiation oncologist recommendations). You may use over the counter products for relief of hemorrhoid inflammation. Warm baths two to three times daily are very soothing. Sitz baths can be purchased at your local drug store

Do NOT smoke cigarettes.

When Should I Call My Doctor?

Diarrhea should not be ignored, since it can result in loss of fluid and nutrition and can be uncomfortable. Call your doctor immediately 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
• no urine for 24 hours
• inability to drink liquids for more than 24 hours
• fever
• weight loss of 5 pounds or more since the diarrhea started
• swollen and/or painful abdomen.
• Progressive weakness, dizziness, heart palpitations

Low Fiber and Low Fat Diet Suggestions

The following diet suggestions are made available to help you avoid foods that will cause bowel irritation and increase diarrhea. Making these changes in your diet can often control the diarrhea in mild cases. You do not need to start this diet until you are having increase stools (more than 2 over your normal).

FOODS TO ELIMINATE	FOODS TO SUBSTITUTE
Fresh fruits and vegetables (except bananas)	Bananas
Canned pineapple, oranges, grapefruit	Canned fruits except those listed
Citrus juices (orange or grapefruit), prune juice, tomato juice	Pear and peach nectars, apple juice
All whole grain cereals, breads, or brown rice, rice, cereals including whole wheat, bran, oatmeal, rye	White bread, corn breads, white cereals (corn & rice)
Tomatoes or tomato based foods such as spaghetti	All other canned vegetables not on the avoidance list
Any gas producing foods such as cooked or dried beans, brussel sprouts, broccoli, cabbage, etc.
Nuts raisins, popcorn, seeds, donuts, rich desserts	May snack on dried cereals, plain flour cookies, cakes
Spicy "HOT" foods (Mexican, Italian, Chinese, Barbecue, Pizza, etc.)	All bland foods (macaroni, noodles, potatoes, etc.)
Fried Foods, processed meats (fried chicken, meat, hamburger, bologna, salami, etc.)	All other baked, broiled, stewed foods
Alcoholic beverages, caffeine (No more than two cups of coffee or caffeine products daily)	Water, Gatorade or other electrolyte replacing drinks, decaffeinated tea, milk (unless sensitive)