Cancer: "I Have Problems Coping With Diarrhea”" HF#481

Diarrhea

 

Diarrhea presents itself as loose or watery stools three or more times a day.  You may or may not have any discomfort with it.  This occurs when food and liquids pass through your body too quickly.

 

Why is it happening to me?

 

It can be a side effect of many of the cancer treatments.  It can occur after chemotherapy, radiation, or a surgery.  If chemotherapy or radiation is the cause, it may last many weeks after the treatment.  Other causes may include infections, anxiety, medicines, stress, or the food you are eating. 

 

Is there anything I should be aware of?

 

Your body may not be able to absorb the water, nutrients, and calories from the things you are eating and drinking.  This may cause dehydration and severe electrolyte problems.  Potassium and sodium are electrolytes that may be lost.  Contact your doctor if the watery stools are severe, bloody, or last for more than a couple of days.

 

Is there anything that I can do to help?

 

Yes.  The rest of this handout will offer food ideas that you may want to try and see if it helps.

 

Fiber

 

A low fiber diet may help decrease cramps and gas and may help you manage and control diarrhea.  If bowel movements occur more often and are softer than usual, it is time to start making some changes to your diet and decrease the amount of fiber in your diet.

 

Ideas to reduce fiber from the grain products you eat.

• Choose breads, cereals, crackers, pasta, and other grain products made with white flour that does not contain any added fiber.
• Choose low fiber cereals such as Corn Flakes^® and Rice Krispies^®.   Read food labels to find other cereals that contain less than 1 gram of fiber per serving.

Avoid the high fiber grains and grain products that are listed in the chart below.

 

Bran	Breads labeled high fiber	Brown rice
Buckwheat	Mixed grain breads	Oatmeal
Peanut flour	Rye flour	Soybean flour
Whole wheat flour	Whole oats	Wild rice

 

 

Ideas to reduce fiber in the fruits you eat.

• Eat fewer fruits and limit portion size
• Choose more juice instead
• Dilute fruit juices with water or club soda.
• Avoid high fiber fruits such as unpeeled apple, avocado, blackberries, blueberries, dates, pears, oranges, prunes, and raisins.

Choose the lower fiber fruits and limit serving sizes as listed below.  The fruits listed below have less than 1.5 grams fiber per ½ cup serving (unless an amount is noted).

 

Applesauce, cooked	Apricots, 4 halves	Banana, ½ medium
Cantaloupe	Cherries, fresh or canned	Fruit cocktail, canned
Fruit juice	Grapefruit sections	Grapes, green or red
Honeydew melon	Mandarin oranges	Mango
Nectarine, ½ medium	Olives, 5 green or black	Peach, peeled
Pineapple	Plums, friar or prune	Tangerine 1 medium
Watermelon

 

Ideas to reduce the fiber from the vegetables you eat.

• Eat smaller portions of vegetables at one time.
• Vegetables may be served fresh or cooked.
• Avoid high fiber vegetables such as broccoli, Brussels sprouts, carrots, corn, green peas, kidney beans, lima beans, pork and beans, potato with skin, pumpkin, rhubarb, spinach, and turnip greens.

Choose the lowest fiber vegetables and limit serving size as listed below.  The vegetables listed below have less than 1.5 grams of fiber per ½ cup serving (unless an amount is noted).

 

Bean sprouts	Beets		Cauliflower
Cucumber, peeled	Eggplant, peeled		Escarole
Green beans	Lettuce, iceberg or leaf		Mushrooms, fresh
Onions	Peppers		Potatoes, ½ cup, peeled
Radish	Squash, acorn, ¼ cup		Sweet potatoes, ¼ cup
Tomatoes, peeled, fresh or canned		Zucchini or summer squash, peeled

 

 

Milk Products

 

During your cancer treatment you may find that your body is no longer able to handle the lactose, a natural sugar found in milk products.  This would cause you to feel cramps, have gas, and even diarrhea.

 

Ideas to help your body handle foods that contain lactose.

• Eat or drink smaller amounts of milk products at one time.  For example, drink ¼ cup or ½ cup of milk instead of 1 cup with your meal.
• Many people find that they are able to handle yogurt with live cultures better than milk or cheese.
• Try reduced lactose products such as low lactose milk and cheese.
• Try products such as Lactaid^® tablets or drops.

Fats

 

Foods that are high in fat may add to and increase the number of loose stools.

 

Ideas to reduce the amount of fat in the foods you eat.

• Choose lean meats, poultry, and vegetables that have been baked, broiled, steamed, or stir-fried without added fat.

• Choose low fat milk, yogurt, cheese, cottage cheese, and other dairy products as tolerated.
• Avoid fried foods and foods served with creamy sauces.
• Avoid dishes that contain high fat items.

Caffeine

 

Caffeine may add to and increase the number of loose stools.  To reduce caffeine in your diet choose decaffeinated coffee, tea, and soft drinks.

 

Spices

 

Most herbs and spices can be used to add flavor to suit your tastes.  There may be some very spicy foods made with curry, chili powder, or hot pepper sauces that you may not be able to handle.

 

Fluids

 

You will want to replace fluids lost from diarrhea.  You can do this by drinking at least 8-10 cups of clear fluids a day.   Try to drink small amounts, such as 1/2 cup, often throughout the day to meet your total fluid needs.   In general, our bodies are in need of extra fluid long before we feel thirsty.

 

Here are some items to think of as clear liquids.

• Water
• Fruit juices and fruit drinks (except prune)- dilute with water or club soda
• Soft drinks and sodas that are caffeine free- dilute with water or club soda.
• Weak decaffeinated teas and coffees.
• Clear soups and broths.
• Popsicles
• Gelatins
• Sports drinks, such as Gatorade^®.   Sports drinks are good at giving your body the extra fluid that it needs.

 

 

Questions Others Have Asked

 

What should I know about sweet foods?

• Avoid large amounts of very sweet foods and liquids.
• Avoid foods with sorbitol, such as sugar-free jellies, jams, and gums.

Can the temperature of the foods I eat affect my stools?

 

Drinking fluids at room temperature may be help decrease your stools or cramping.

Hot or cold liquids may cause bowel movements.  You will need to see what works for you.

 

Does the size of the meal I eat matter?

 

Yes, it does.  Eat small amounts of food and liquid throughout the day instead of three larger meals. Large amounts of food at one time may bring about a bowel movement.

 

What about fiber supplements?

 

They are something worth trying.  The type of fiber that you will want to use are the water soluble fiber supplements.  Metamucil^® would be an example of what you could buy as a fiber supplement.  You could also try pectin such as Sure-Jell^®.  They should help by thickening the stool and be able to absorb bile salts in the bowel.  Bile salt can irritate the lining of your bowel.

 

How do I replace salt in my diet?

 

Eat foods and drink liquids that contain salt such as broth, bouillon, most store bought soups, spaghetti sauces, tomato juice, pretzels, and cheese.  Do not take salt pills.

 

How do I replace potassium in my diet?

 

Choose foods and liquids that contain potassium such as bananas, baked or boiled potatoes, apricot nectar, peach nectar, orange juice, pineapple juice, tomato juice, and meats.

 

I have tried a few ideas and I still need to run to the bathroom.

 

If the loose stools persist, you might try to limit your intake to only the foods that follow.

• Bananas
• White rice
• Cream of rice
• Mashed potatoes
• Peeled apples
• Yogurt with live cultures
• Caffeine free tea
• White toast
• Plain bagels
• Noodles
• Eggs
• Lean meat or poultry without added fats

Try this for only a few days. If bowel movements continue to be very loose, watery, and frequent you need to contact your doctor.

 

What should I drink if my diarrhea is severe?

 

Pedialyte^® is a good example of a drink that has the electrolytes your body needs.   You can purchase Pedialyte^® or any of the other similar products on the market.  You could even make your own at home.

 

Homemade Electrolyte Replacement Solution for adults

• 1 teaspoon salt
• 1 teaspoon baking soda
• 1 Tablespoon corn syrup
• 1 - 6 ounce can frozen orange juice
• 6 cups water

Mix all items.  Add enough water to make 1 ½ quarts.  Refrigerate. Shake well before serving. 

1 quart= 100 meq NA, 20 meq K, 97 meq phosphorus, 105 g carbohydrate, 4 g protein, 225 calories

 

The World Health Organization suggests that fluid used to restore hydration for an adult has 90 meq NA, 20 meq K, 30 meq bicarb per quart.  For children, you will want a fluid that has 45 meq Na, 20 meq K, 25 g carbohydrate, 100 calories per quart.  Pedialyte^® is a good example.

 

We hope that this handout will help you manage and improve the diarrhea that you are having.  At the same time you will be able to maintain your weight and process of healing. Once things have settled down, you can slowly add the foods that you had taken out of your diet.

 

Check with your doctor right away if you have symptoms of severe fluid loss such as a decreased need to void, dark yellow urine, dry lips and mouth, feeling dizzy, or tired.

 

If you are a UW Health patient  and have further questions or concerns, please call the nutritionist at the University of Wisconsin Comprehensive Cancer Center, (608)-263-9128.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 08/14/2012

Copyright © 06/22/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#481

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