Coping with Constipation and Diarrhea - the Rear-End Roller Coaster

Constipation is a fact of life in western life, due in considerable part to our often nearly fiber-free diet.  A colorectal surgeon speaking on cancer opened by saying that there are two kinds of people among his patients: the constipated and the very constipated!

While many of us will experience diarrhea in the treatment and early post-treatment stage, constipation is a looming threat.  Hard stools will irritate scars from the site of the tumor (removal or biopsy) and delay healing.  Constipation from a diet low in fiber (the standard US diet now), perhaps aggravated by pain medications –virtually all have constipating effects – can contribute to numerous colorectal problems.   The goal is to seek a balance, avoiding multiple sessions on the toilet as well as an impacted bowel!   A basic overview is here. If your cancer treatment center has a nutrition specialist, seek his or her advice on diet and management of constipation and diarrhea.  If not, ask your oncologist or your colorectal surgeon for a referral to an expert.   See also this comprehensive report on digestive issues from a UK site for cancer patients.   The M.D.Anderson Cancer Center provides a very detailed guide to bowel management here.

 Treating Diarrhea

 Anti-diarrhea diets – based on the famous BRAT rule – Bananas, Rice, Applesauce and Toast (white) – are almost entirely devoid of fiber.  You may find this helpful for temporary diarrhea problems, but this diet is not recommended for use beyond a few days, as it is not adequate for nutrition.   Bouts of diarrhea can also be addressed with the non-prescription medication loperamide HCl, brand-name Imodium.  This will control the symptoms of diarrhea but not the underlying cause.  Extended or intensive use may switch you over to constipation.  Always consult with your doctor if the diarrhea – or constipation – lasts for more than a few days.

If diarrhea has left you with irritated skin around the anus, there are many protectants you can try to eliminate the problem. Petroleum jelly, corn starch, zinc oxide (an ingredient in diaper rash ointment, are some to try. with a If the itching persists, or a rash forms, your dermatologist or oncologist can prescribe an ointment such as Desonide to clear it up.  Use baby wipes if toilet paper is too harsh.  A folded gauze pad can help wick off moisture that is helping to cause the irritation.  You may also get some relief by using a pad in your undergarments. 

More information on diarrhea is here; see also the Mayo Clinic guide to cancer and diarrhea.  Diet can be helpful in controlling diarrhea, and recent controlled clinical studies have shown that probiotic supplements can reduce its frequency.

Incontinence underwear can provide great peace of mind when you must be out of your house and beyond "quick sprint" distance to the toilet.  There are numerous options; underwareness is a favorite of a fellow patient.

Urinary incontinence, if severe, can be treated surgically.

 Treating Constipation

When constipation hits, the non-prescription ducosate sodium, sold as Colace (offered under their own label by drugstores and other chain stores) helps soften stools, reducing their impact as they travel through the anal canal and exit the anus. It comes in 100 mg and 50 mg sizes.  A mild vegetable-based laxative, senna, sold as Senokot and also available under various labels, can be purchased with or without a stool softener added.   Ask your doctor about these products, and others s/he would recommend.  Psyllium powder should be continued (or started if you have not been taking it).

 Fiber, More Fiber!

When you are able to move, however slowly, towards a more normal diet, one key factor is fiber – dietary recommendations from the US government as well as medical experts agree on a minimum of 25 grams of fiber daily, and some – such as my colorectal surgeon – call for at least 30 grams.  A balance of other diet elements is also needed – restricted intake of fat, particularly animal fats, for example, which can contribute to diarrhea.   You will find detailed recommendations on diet in several of the books listed elsewhere on this site.  Talk to your doctors about this!  A balanced diet is an essential element of the long-term fight against cancer (and other debilitating problems such as heart disease).

Several products can be added to your routine to help with fiber – there are fiber tablets for example, particularly useful for travel; psyllium husk powder (a plant fiber, sold as Metamucil, and under various labels by many drugstores, health food stores or other chain stores); fiber bars; and fiber-rich cereals.  Try them!  For some medical advice about fiber, see this Web MD link.

Add Friendly Bacteria

Probiotics - the bacteria that live in your colon and assist in colon health – can be severely affected by chemotherapy drugs.   You can help restore them by eating yogurt with active cultures; if you prefer not to eat dairy products, the alternative is a probiotic supplement.  My gastroenterologist recommended Align, and another doctor Philips Colon Health.  My colorectal surgeon indicated that a variety of biotics in the preparation is more important than the number of bacteria (10 billlion! 50 billion!) claimed.  Consult with your doctor to see if s/he has a recommendation.   Some forms require refrigeration, and others do not; the latter is easier for travel purposes.

A Rear End Journal

 Keep a record of bowel movements, and of your diet; this can help you and your doctor see patterns, and get the right solution.  I began such a journal during my treatment, and I know that it’s tedious and sometimes embarrassing to write down everything you eat! But, when I had two bouts of extreme nausea, vomiting and diarrhea that resulted in hospitalization, the journal helped identify the cause.  And if you have trouble with weight gain or loss, such a journal will also assist you to see if the problem is simply too many or too few calories or something more serious.

Don’t Forget the Water!

Whether you are experiencing diarrhea or constipation, good hydration is key.    Adequate fluid will help ease constipation; it’s also necessary to replace fluids lost with diarrhea.  It’s useful to keep a record until you are sure you are getting the 64 oz of fluid generally recommended (which does not have to be all water, but should be all coffee either!).  One US Army researcher recommends a simple test – is your urine in the morning light or dark?  If it’s dark, like apple juice, you are dehydrated!  


© H. M. Carter-Tripp 2012