Bowel Problems

Constipation

The anti-nausea drugs, Aloxi, Navoban, Zofran and Kytril, and some anti-cancer drugs can cause constipation.

It is recommended that you commence an aperient (laxative) the day your chemotherapy starts. You should continue taking the aperient until you have finished your course of anti-nausea drugs and your normal bowel habits have been re-established.

If constipation persists, contact your GP or the NCI. No more than 2 days should pass without a bowel motion.

Some suggestions to prevent or relieve constipation include:

  • Drink plenty of fluids

  • Include high fibre foods in your diet (e.g. bran, raw fruits & vegetables, wholegrain breads & nuts)

  • Maintain a normal level of activity or exercise, if possible

Faecal softeners or other aperients will almost always be required. If you have a history of constipation, start taking an aperient the night before chemotherapy.

Coloxyl with Senna – Take 1-2 tablets at night, or increase to 3 times a day if necessary.
Coloxyl 120 mg – Take 1-2 tablets at night, or increase to 3 times a day if necessary.
Movicol sachets – Mix 1 sachet in 120 mls of water. A maximum of 8 sachets per day can be taken.

If, despite the above, your bowels still have not opened in 2 days and you have increased your aperient usage and fluid intake – PLEASE CONTACT THE NURSING STAFF. After discussing this with the nursing staff you can try one Glycerine and one Durolax suppository inserted in the rectum.

If this still does not work, contact your GP.

Constipation:

Constipation is common and can be caused by your disease, or by drugs (such as chemotherapy, anti-nausea medications or pain killers). Changes in lifestyle can also affect your bowel function and regularity (e.g. not being able to eat or exercise the way you used to)

TIP: If you are having chemotherapy that includes constipating anti-nausea medications (such as Zofran or Aloxi), it is much easier to prevent constipation by using a mild laxative such as Coloxyl or Movicol, than try to deal with constipation after the fact! Ask your nurse what to expect from your particular regime.

What should I do to avoid constipation?

  • Eat a high fiber diet. Choose food that is high in fibre. Add new fibre foods gradually to give your body time to adjust. For a list of foods that are high in fibre please see the attached sheet.

  • Drink 6- 8 glasses of water daily. Getting plenty of liquids washes waste and toxins out of your body. But coffee, whole milk and sodas can actually contribute to constipation. Water is the best drink for relieving constipation and overall health.

  • Exercise regularly. Moving your body from the outside helps keep things moving on the inside. It doesn't much matter how you increase your physical activity. Just do it. 30 minutes a day can work wonders.

  • Avoid "hard" animal fats. You can reduce your problem by reducing foods that cause constipation, such as cheese, ice cream, whole milk, fatty meats, sugar processed foods and pastries. And you'll keep your colon well lubricated by eating more essential fatty acids, such as omega 3 fish oil.

  • Reduce stress. Relaxation helps loosen up your whole body. Eliminate as much stress as possible and take the time to maintain a positive attitude and get plenty of rest. Laughter is especially good for massaging the intestines.

  • Include a fiber supplement, which should not replace good high fiber foods. You can buy daily fiber supplements at most health food stores. A morning fiber drink (with plenty of water), just after your big glass of water, works well.

  • Make time for healthy elimination. Be sure to establish good elimination habits. In the beginning, you may need to give it more focus.

What Medication can I take to stop constipation?

Discuss the different options with your oncology nurse or doctor.

  • Stool Softeners or Emolient Laxatives eg: Coloxyl or Docusate Sodium. These are a safe first line treatment for constipation as it will not cause cramping. These medications act as softeners by helping water penetrate the faeces making them easier to pass. These types of laxatives are also useful if you suffer from haemorrhoids.

  • Stimulant Laxatives eg: Senokot. These work by stimulating the bowel to move the contents along. Sometimes this is used in combination with softeners (eg: Coloxyl and senna)

    If you have had bowel surgery, you should be very careful using stimulant laxatives. You should check with your surgeon first before using.

  • Fibre or Bulk Forming Laxatives eg: Metamucil or Psyllium seed. Fibre is a plant material that is not absorbed by the bowel. It is important to make sure you are drinking adequate water while using them. You may have to experiment to find the best source of fibre for you, as sometimes increased gas can be a side effect, so start at a low dose and slowly increase.

  • Iso-osmolar Laxatives eg: Movicol. These relieve constipation by drawing water into the bowel instead of it being reabsorbed by the body. Movicol is a safe for short or long term use and does not require you to drink large mouthfuls of fluid. It will not cause cramping or gas.

  • Enema or Suppositories. Inserted rectally and used to evacuate hard or compacted faeces from the rectum. Should also be used in conjunction with an oral preparation. Be careful when using suppositories when you blood counts are low, as broken skin can be a route of entry for infection.

Diarrhoea:

What is Diarrhoea?

Diarrhoea is the condition of three or more liquid or loose bowel movements a day. Causes might include certain types of Chemotherapy, Radiation Treatment, Anxiety, Infection or recent bowel surgery.

It is important to control diarrhoea as not only can you become dehydrated due to loss of fluid, it can become difficult to go about normal daily activities when you continually have to be aware of the nearest bathroom. It can also contribute to nutritional problems and fatigue.

What Should I do if I suffer from diarrhoera?

To prevent an imbalance of the normal bowel flora which can cause diarrhoea, preparations of Pro-Biotics (available in Pharmacies, Health Food Shops and Supermarkets) can be taken.

Your electrolytes as well as fluid need to be replaced if you suffer from diarrhoea over a longer period. Rehydration solutions high in Potassium and Sodium (such as Sports Drinks or Electrolyte Replacement Drinks/Powder) can be purchased at any pharmacy or supermarket. Home-made drinks of salt and sugar mix should be avoided as they could dehydrate the body further.

Avoid spicy or fatty foods for a few days. The "BRAT" Diet (Banana, Rise, Apple–raw or stewed, Toast) can alleviate diarrhoea as well.

Diarrhoea can be caused by some chemotherapy drugs, or by anxiety.

If diarrhoea continues for more than 24 hours or if you are experiencing pain or cramping, call your local doctor as it may be necessary to take anti-diarrhoea drugs.

Some ways you may be able to control diarrhoea include:

  • Drink small amounts frequently to replace fluids you have lost

  • Drink clear fluids such as weak apple juice, water, weak tea or clear broth

  • The fluids should be taken at room temperature or warmed

  • Let carbonated drinks lose their fizz before you drink them

  • Eat smaller amounts of food but eat more frequently

  • Try plain foods instead of spicy or fried foods

  • Eat potassium rich foods and beverages like bananas, potatoes and sports

  • Alcohol, fruit juices and strong tea or coffee may stimulate the bowel so these should be avoided where possible

If you have severe pain or cramping in your bowels or notice blood or black discolouration contact the NCI staff.

  • Imodium – Take 2 capsules initially, then take 1 capsule after each loose bowel motion, but do not exceed 8 capsules in any 24 hour period. If diarrhoea continues, contact your doctor.

  • Lomotil – Take 1 tablet after each loose bowel motion.

If diarrhoea continues, contact your GP.