Diarrhoea

Diarrhoea (frequent soft, loose or watery bowel movements) is a symptom that people with cancer commonly suffer from. When you have diarrhoea, foods and liquids can pass through the bowel too quickly to allow your body to absorb the right amount of nutrition, vitamins, minerals and water that it needs. This may cause you to become dehydrated so it is very important that you drink plenty of water (ideally at least 2-3 litres a day). Diarrhoea and stomach cramping can be very unpleasant, painful and often embarrassing, but there are some effective treatments available that can help to control it. Although it may not always be possible to completely control the diarrhoea, there are many things that can be done to help slow it down.

Medication

Make sure you stop taking any laxatives (medications to help with constipation such as Senna, Dulcolax or Laxido) as they can cause diarrhoea (loose or watery stools) and/or cramps.

If you have been prescribed anti-diarrhoea medication such as Loperamide (Imodium) or anti-spasmodic medication such as Hyoscine (Buscopan) or Mebeverine (Colofac) by your doctor, take the dose that you have been recommended as soon as you first have diarrhoea. You should take your anti-diarrhoea drugs as regularly as recommended by your doctor, in your treatment information or as advised by a pharmacist or in the drug information. Do not exceed the maximum dose that you have been prescribed or indicated on the drug information.

If you have diarrhoea but have not been prescribed any form of anti-diarrhoea medication, please contact your hospital medical team for further advice.

Eating and Fluid Intake

The dietary advice on this page may not be applicable to you such as if you have diabetes, have had oral, stomach or bowel surgery or have difficulty chewing or swallowing. In these situations please contact your medical team for dietary advice that is relevant to you.

Certain types of food and drink can affect diarrhoea. For example, although eating fibre is very important for a healthy diet, fibre can make diarrhoea worse. Therefore when you have diarrhoea you should avoid high fibre food and drinks.

Eating

You could try low fibre foods that are light, bland and easy to digest such as:

White bread and foods made with white flour/corn flour.

Cornflakes^®, Rice Krispies^®, Special K^®, Frosties^® or Coco Pops^®.

White rice and white pasta.

Biscuits and cakes made with white flour e.g. crumpets, plain scones, cream crackers, plain cake.

Yoghurt without seeds/pips/nuts.

Cheeses, eggs, butter, margarine, milk puddings.

Clear soups and cream soups without vegetables.

Peeled, de-seeded and cooked vegetables (if you want to eat them).

Small frequent meals and snacks throughout the day.

When you have diarrhoea your body loses sodium (salt) and potassium so it is important to try and replace these dietary minerals and electrolytes. You could try eating foods high in potassium such as bananas, fish, and baked, boiled, or mashed potatoes and foods high in sodium such as savoury snacks, ready-made meals and some soups.

Try to avoid:

High fibre foods such as whole wheat breads, pasta and cereals (such as muesli and bran), cooked dried beans, pulses, raw fruit and vegetables, unripe or dried fruit, nuts and seeds.

Skin, seeds and pith from fruit and vegetables.

Eating lots of milk and dairy products, such as cheese, ice cream, sour cream, butter and cream.

Foods that are spicy or pickled such as pepper, hot sauce, salsa, chilli and curry dishes.

Sugar free sweets (such as mints and chewing gum) and other food products containing the sweeteners sorbitol or xylitol. Read product labels to find out if they contain these sweeteners.

Eating lots of meat products such as sausages, bacon and pork, particularly if the meat has been twice cooked.

Eating lots of greasy, fatty, or fried foods such as chips, fast foods, burgers and sausages as these types of foods can make diarrhoea worse. Trim off any visible fat on meat before eating.

Fluid Intake

Diarrhoea can cause people to become quickly dehydrated. If you experience diarrhoea it is very important that you drink plenty of fluids (ideally 2-3 litres a day).

You could try:

Taking small sips slowly throughout the day rather than trying to drink large amounts of fluid at once.

Water, non-fizzy drinks such as squash, tea, coffee, herbal tea and clear soups (such as bouillon, consommé and clear broth). If you do want to have fizzy drinks (e.g. cola), let them lose their fizz before you drink them.

If you would like to drink fresh fruit or vegetable juice then limit these to just 1 small glass a day.

Try to avoid:

Drinking alcohol.

Lots of drinks that have caffeine in them such as coffee, tea, hot chocolate and cola.

Coping and Being Prepared

Having diarrhoea can be very exhausting and you may find that you have very little energy to do anything. There are some simple things you can do that can make life easier for yourself when you have diarrhoea.

Resting

You may feel very tired and weak if you have become dehydrated, so it is very important to let your body rest when you can. Make your surroundings comfortable so that you can totally relax. If possible, ask family or friends to help you with things like cooking, housework, shopping and collecting children from school so that you can rest.

There are lots of things that you can do by yourself or with the help of a friend or relative that may help you to cope with diarrhoea.

Being Prepared When You Go Out

Sometimes people worry about making trips out when they have diarrhoea. You may feel that you want to be close to a toilet at all times to avoid accidents. If an accident does happen it is entirely natural to feel embarrassed and upset, even if no one else knows about it. Planning ahead can help to give you confidence in going away from home.

You may find the following tips useful:

Find out exactly where the toilets are in the place you are going.

Try not to go on long car, train or bus journeys.

Take an ‘emergency kit’ with you consisting of: spare clothing and underwear, some alcohol free moist toilet wipes or baby wipes and some soothing cream. If you have a colostomy, take a spare colostomy bag with you.

Personal Care

It is very important to look after the skin around your anal area when you have diarrhoea, as it can quickly become very sore and the skin may even break.

Instead of using toilet paper, use moist toilet paper or damp cotton wool to wipe yourself with.

Clean or wipe yourself with unscented and alcohol free soaps or cleansing solutions or wipes that will be gentle on your skin. Use warm water (not too hot) as this will help to soothe any pain. Avoid using flannels or sponges as they can be very rough on your skin and are hard to keep clean.

When drying your anal area, gently pat the area with a soft towel. Do not rub as this can make the skin sore.

Try using a barrier or soothing cream such as Sudocrem or Germolene on the sore area. If you prefer more natural remedies you could try dabbing the sore area with a small amount of diluted witch hazel on some wet cotton wool or applying some aloe vera gel.

Try not to scratch the anal area.

Overflow diarrhoea

This happens when constipated poo in your bowel is so hard that you cannot push it out. Sometimes the bowel begins to leak out watery stools around the poo from much higher up in the bowel. This passes round the blockage and out of your bottom.

The leakage from the bowel can cause soiling on your underwear and can also appear like diarrhoea. Doctors call this overflow diarrhoea. In this situation you should not take anti diarrhoea medicines. So if you have had severe constipation and then develop diarrhoea, you must talk to your doctor or nurse before taking any medication to stop diarrhoea.