Keep loose stools under control

Diarrhea is the passing of loose or watery stools three or more times a day, which may cause cramps in the abdomen and pain or discomfort in the rectum. When mild, diarrhea is an inconvenience, but left untreated it can lead to serious problems, such as dehydration, loss of important nutrients, weight loss and fatigue.

Why does diarrhea occur?

Diarrhea can be caused by the inability of the intestines to absorb water, overaction of the muscle layer of the intestine, or damage to the rapidly dividing cells that line the intestines so they cannot perform their function of absorbing liquids.

Who is most likely to be affected by diarrhea?

Diarrhea is most likely to affect individuals who had surgery on the intestines, who are being treated with radiation to the abdominal area, or who are receiving certain chemotherapy drugs, especially 5-fluorouracil, capecitabine and irinotecan. Diarrhea also can occur in people taking targeted therapy drugs, although it is usually mild. In addition, people who receive a bone marrow transplant are often affected.

Diarrhea may also develop in some people who take antibiotics as part of their cancer treatment. Antibiotic-associated diarrhea can be serious and even life-threatening. Virtually any antibiotic can cause antibiotic-associated diarrhea, but those that most commonly cause diarrhea are ampicillin, clindamycin and cephalosporins.

When does diarrhea occur?

Cancer treatment-related diarrhea is a short-term side effect that typically occurs within the first few days or a week after treatment and usually resolves within a few weeks after the end of treatment. Diarrhea caused by bone marrow transplantation may last for a week to a few months after the end of treatment.

How can diarrhea be managed?

Changes in diet can help prevent or lessen diarrhea (Table 1). Once diarrhea occurs, following a diet of only clear liquids may help the lining of your intestines heal. Clear liquids include water, cranberry juice, ginger ale, clear broth, Popsicles, decaffeinated tea and Jell-O. As diarrhea begins to improve, you can slowly add solid foods to your diet, starting with low-fiber foods (such as white rice or boiled potatoes). Some foods can make diarrhea worse, such as dairy products (milk, cheese and sour cream); spicy, greasy or fried foods; raw fruits or vegetables; or foods that are high in fiber (whole-wheat breads, granola and bran cereals).

When you have diarrhea, your body loses fluid and important minerals. Because of this, it is important to drink plenty of clear liquids to help replace fluids in your body. You should also eat foods that are high in potassium, like spinach, soybeans, lentils, beans and dried apricot, as this important mineral is often lost during diarrhea.

Over-the-counter medicines and fiber supplements are also available to control diarrhea, but be sure to talk to your doctor first, who may give you instructions that differ from those on the drug label. If diarrhea is severe, your doctor may prescribe other medications or may also stop treatment with chemotherapy or targeted therapy temporarily and restart it when your diarrhea is controlled.

You might even know when to anticipate bouts of diarrhea based on prior episodes you have experienced while receiving chemotherapy. If so, mark your calendar so that you aren’t scheduling yourself to be out for a walk or having company over when it is most likely to happen.

Severe diarrhea may cause discomfort in the rectal area. To help soothe this area, clean the external rectal area with warm water and soap after bowel movements, soak in a warm bath, or use a water-repellent cream.

Table 1. Ways to help prevent diarrhea
Drink six to eight glasses of fluid per day
Examples: water, sports drinks (Gatorade), broth
Avoid beverages with alcohol or caffeine
Examples: beer, wine, cola, coffee, black tea
Eat bland, low-fiber foods
Examples: boiled white rice, cheese, boiled chicken, mashed potatoes
Eat foods high in protein, calories, and potassium that are easy to digest
Examples: cottage cheese, eggs, baked potatoes, cooked cereals, bananas, macaroni and pasta, white toast, applesauce, apricots, crackers, pretzels, smooth peanut butter
Eat more frequently but in smaller amounts
Example: Eat five to six small meals rather than three large meals
Avoid foods that are very high in fat
Examples: fried or greasy food, cream sauces
Avoid fluids and food that can irritate the digestive tract
Examples: caffeine (cola, coffee, tea), alcohol, milk or milk products, chocolate, dried fruits, beans, popcorn, spicy food
Avoid very hot and cold beverages
Examples: Extra hot coffee or tea or iced beverages

When should I talk to my doctor about diarrhea?

Talking about diarrhea may seem embarrassing, but it is important to avoid complications. Talk to your doctor if your diarrhea does not improve with over-the-counter medicines, especially if you have recently been taking antibiotics. Also, call your doctor if you have symptoms of severe dehydration, such as dizziness or fainting.

Call your doctor immediately if you:

  • Have six or more loose bowel movements per day for more than two days in a row
  • Notice blood in the stool, around the anal area, on the toilet paper, or in the toilet bowl
  • Cannot urinate for at least 12 hours
  • Have signs of a fever
  • Lose five pounds or more after the diarrhea starts
  • Have a swollen and/or painful abdomen
  • Feel dizzy or lightheaded when moving to a standing position