People with cancer sometimes experience diarrhea — frequent loose, watery bowel movements occurring 3 or more times a day. Diarrhea most commonly can be triggered by some chemotherapy medications, other medications such as antibiotics, radiation to the gastrointestinal tract, by the cancer itself, infections, and supplemental feedings (usually high protein liquids like Ensure and Sustecal). Sometimes diarrhea can also be caused by laxatives taken to prevent constipation, other non-cancer conditions, and reactions to food.

Diarrhea, a relatively common side effect, requires your immediate attention. You should let your health care team know at once if you are experiencing diarrhea, even if your initial symptoms are mild. Untreated diarrhea can lead to dehydration, a significant loss of fluid and electrolytes (like potassium, magnesium and sodium) from the body. Dehydration can trigger severe side effects, and even become life-threatening.

Your health care providers will want to determine the cause of your diarrhea so that effective treatment can begin.

Symptoms

People with diarrhea may experience some or most of these symptoms:

• Abnormally frequent, more fluid bowel movements for more than one day
• Cramping or abdominal pain
• Tender rectal area
• Blood in the stool
• Significant reduction in passing urine

Prevention

While not every cancer patient experiences diarrhea, for people taking certain chemotherapy medications, complete prevention of diarrhea may not be possible. You should ask your health care provider if your chemotherapy medication, or combination of medications, is likely to trigger diarrhea, so that treatment can be planned if this happens.

It is important to understand that diarrhea, once its cause is understood, can be effectively treated in people with cancer, even if prevention may prove difficult.

Treatment

Here's how to help your health care team treat your diarrhea:

• Don't delay in letting your care providers know you are experiencing diarrhea.
  
• Be accurate, complete and honest about your symptoms.
  
• Keep track of how often you are having bowel movements in a 24-hour period.
  
• Describe the bowel movements: how frequent, how much volume, hardness, presence or absence of blood, and so forth.
  
• How soon did the diarrhea begin after chemotherapy treatment?
  
• Are you feeling cramping pain when you move your bowels?
  
• Be ready to describe all medicines, and their doses, that you take — not only chemotherapy medicines, but anything else you use regularly. Don't forget to mention over-the-counter medications that you use, as well.

Your physician will probably do a physical examination, including a rectal exam, and collect stool for analysis in a laboratory. You may also be asked to provide a urine sample. Sometimes, if the cause of diarrhea is not clear, your health care team may have an x-ray done to see if your bowel is blocked.

How you are treated for diarrhea will depend on what is causing it. In some cases, when diarrhea is severe, a person may need intravenous (IV) fluids to restore a fluid and electrolyte balance to the body.

Dietary change. Sometimes making changes in your diet will help bring mild diarrhea under control. If your health care provider recommends dietary changes, discuss specific recommendations that are best for you. It's very important to maintain good nourishment even with diarrhea, for your overall health and strength, so it's essential that you eat food and drink liquids that are both nourishing and soothing. Many health care facilities that treat people with cancer have registered dieticians on staff; ask your health care team to consult with these individuals about your diet.

Try These Foods and Liquids

• Drink 8-10 glasses of fluid a day. Clear fluids, such as water, some fruit juices (apple, cranberry), broth, decaffeinated teas, and soft drinks like ginger ale that have been allowed to go flat, are often recommended. Drinking plenty of fluids, especially when you have diarrhea, is very important to avoid dehydration.
  
  
  • For some people, drinking liquids specially formulated with minerals, such as Gatorade and Pedialyte, may be helpful — but they are not right for everyone. Check with your health care provider.
  
  
• Eat foods that are known to be gentle on the bowels:
  
  
  • The BRAT Diet - bananas, rice, apples and toast
  • Smooth peanut butter
  • Skinless chicken or turkey
  • Cereals that are rice- or oat-based
  • Fish
  • Washed, peeled fruit such as apples, peaches, nectarines
  • Cooked (not raw!) vegetables
  • Angel food cake, graham crackers, vanilla wafers
  
  
• Avoid These Foods and Liquids
  
  
  • High fat, greasy and spicy foods — such as hot dogs, pizza, sausage, bacon
  • Beverages containing caffeine — coffee, tea, soft drinks
  • Raw vegetables
  • Bran of any kind: wheat bran, whole wheat breads, bran cereals
  • Dried fruits
  • Nuts
  • Popcorn

Milk. Some people are lactose-intolerant, meaning they have difficulty digesting milk sugar. Sometimes people are born with this condition, but it can also develop as a result of some cancer treatments. If eating and drinking products like milk and ice cream appear to be contributing to your diarrhea, either use lactose-free products (milk in this form is found everywhere) or consider using lactase supplements (replacing your deficiency of lactase, the enzyme that helps you digest milk sugar) before eating and drinking products containing lactose.

Chemotherapy mediations can cause diarrhea. If your physician determines that the chemotherapy being used to treat your cancer is contributing to your diarrhea, she may prescribe medications that act on your bowel activity, slowing it to allow your intestines to absorb nutrients from food and liquids. There are a number of different medication approaches to controlling chemotherapy-caused diarrhea, and your health care team will work to find the best approach for you.

Antibiotics. Some people who have been treated with numerous broad-spectrum antibiotics have diarrhea caused by an imbalance of different forms of bacteria that live in the intestinal tract. Treatment involves using other antibiotics such as metronidazole (Flagyl) or vancomycin (Vancocin) to rebalance bacteria in the intestines.

Fat digestion problems. Some people may have trouble digesting fats. Treatment will involve determining the cause and providing appropriate medication.

Colon irritations from absorption problems. This condition is treated by medication.

Skin care is important in helping to manage your diarrhea as comfortably as possible. Keep the rectal area clean, cleaning it with mild soap and water after bowel movements. Applying a water-repellant cream to the anal area can also ease discomfort and itching. Ask your health care team for a recommended product to use.

Questions for Your Doctor

In treating diarrhea, your health care team may include an oncologist, internist, nurse and registered dietician.

1. Does my chemotherapy medication often cause diarrhea? If so, how can we control this side effect best?
   
   
2. How long will my diarrhea last?
   
   
3. What foods and beverages should I take while I have diarrhea? Which ones should I avoid?
   
   
4. Should I consider beverages like Pedialyte and Gatorade?
   
   
5. What medications can help me manage diarrhea?

More Information

The National Cancer Institute reports that the following chemotherapy medications contribute to diarrhea:

• capecitabine (Xeloda)
• cisplatin (Platinol)
• cyclophosphamide (Cytoxan)
• cytosine arabinoside (Ara-c, Cytosar-U)
• danorubicin (Cerubidine)
• docetaxel (Taxotere)
• doxorubicin (Adriamycin)
• 5-fluorouracil (5-FU)
• interferon (Intron, Roferon)
• irinotecan (Camptosar, CPT-11)
• leucovorin (Leucovorin Calcium)
• methotrexate (Mexate, MTX)
• oxaliplatin (Eloxatin)
• paclitaxel (Taxol)
• topotecan (Hycamtin)

Chemotherapy medications work to destroy rapidly dividing cells — cancer cells included. Unfortunately, they can also affect other healthy cells, such as those in the intestinal wall. By temporarily damaging the intestine lining, the chemotherapy alters the delicate balance of fluids there, sometimes resulting in diarrhea.

Medications to Treat Diarrhea

These are some of the key medications most often used to treat chemotherapy-related diarrhea. Your health care team will recommend the ones most appropriate for you. Do not take over-the counter or other anti-diarrhea medications without a health professional's advice.

• Synthetic opioids — medications like loperamide (Imodium) and diphenoxylate (Lomotil) work by slowing down the intestines, and allowing them to absorb nutrients from food and drink. Both are oral medications.
  
  
• Octreotide (Sandostatin) — this medication, used to treat some cancers, also can control the fluid secretions in the intestine, helping to prevent dehydration. This medication is administered by injection into a vein or under the skin, and is effective for severe diarrhea.

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