Diarrhea

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Diarrhea is defined as an abnormal increase in both the number of stools passed and a change in consistency 04' stools from formed to liquid. It may be accompanied by intestinal cramping.

Patients with cancer sometimes experience diarrhea for a variety of reasons. A person's bowel pattern may permanently change after intestinal surgery. Certain chemotherapy medicines affect the motility of the gut, causing an increase in the number of stools per day. Antibiotics can change the balance of normal bacteria in the intestines, resulting in diarrhea. Diarrhea is a common side effect of radiation therapy to the abdomen. Finally, people who are lactose intolerant may have diarrhea after eating dairy products.

If you experience diarrhea, there are a number of steps you can take to minimize complications

Dietary changes

• Replace lost fluid by increasing your intake of liquids. This may include water, tea, ginger ale, Popsicles, Gatorade, broth, Pedialyte, or non-citrus juices.

• Follow the BRAT diet: Bananas, white rice, applesauce, non-caffeinated tea and toast.

• Eat smaller, more frequent meals.

• Avoid foods and beverages at extreme temperatures.

• Avoid spicy or fatty foods.

• Avoid milk products.

• Avoid caffeine.

• Avoid nicotine.

• If you experience more diarrhea and gas after eating dairy products, avoid them, or replace them with soy or lactose-free products.

Medication

Imodium: Available over the counter, lmodium (Ioperamide) may be taken as directed on the package. The usual dose is 2 tablets taken after the first loose bowel movement, followed by 1 tablet after each additional loose bowel movement, not to exceed 8 tablets per day.

• Lomotil: This requires a prescription, and can be helpful in patients whose diarrhea is not relieved by Imodium. The dosage is the same.

• Tincture of Opium: This can be very helpful in severe or chronic diarrhea. It requires a triplicate (handwritten) prescription from your physician.

• Kaopectate and Pepto Bismol should be avoided if you are receiving chemotherapy, since both contain aspirin.

• If you have been taking stool softeners or laxatives prior to the onset of diarrhea, discontinue them until your bowel function returns to your baseline.

Comfort measures

• Clean the rectal area after each bowel movement with mild soap and water or baby wipes.

• Soaking in a warm tub may soothe irritated skin in the perianal area.

• A hot water bottle or heating pad on the abdomen may help lessen cramping.

Let your physician or nurse know if any of the following occur:

• Fever over 100.4 degrees Fahrenheit.

• Severe abdominal pain.

• Inability to drink adequate amounts of fluid.

• Weakness or dizziness.

• Weight loss.

• Blood in the stool, or black, tarry stool.

• Rapid heart rate

Feel free to use the above information as a guide, but remember, it is not a substitute for good communication with your health care team. During the day, the oncology nurses are available by phone and voice mail, and a physician is available 24 hours a day and on the weekends, through our main office phone number, (415) 923-3012.