Diarrhea isn’t the easiest thing to discuss with your provider, but a change in frequency of bowel movements is important information and needs to be addressed.
While occasional episodes of diarrhea are considered normal, severe diarrhea can have a significant impact on your cancer treatment. It may even lead to dose reductions or delays in your treatment plan.
Uncontrolled diarrhea can also cause several issues impacting overall well-being.
- Fatigue as your body loses nutrients and fluids, which deprives the body of the necessary resources it needs to maintain optimal energy levels. As a result, you may feel tired and weak.
- Dehydration and Electrolyte Imbalances are also a concern, as excessive fluid loss during uncontrolled diarrhea can lead to organ damage, shock, and even fainting or coma. Water is essential for delivering nutrients, maintaining heart rate, and removing waste from the body.
- Malnutrition from persistent diarrhea can occur as body has reduced ability to absorb essential nutrients.
Dealing with diarrhea is not easy, but understanding why it happens can help you take steps to manage diarrhea effectively.
Why Does IT happen?
Many side effects of treatments, surgeries, or cancer itself can damage the intestine, change motility, and/or impact digestion and absorption. Some common causes:
- Side effects of medications, chemotherapy, and immunotherapy
- Pancreatic insufficiency
- Radiation therapy to the pelvis
- Surgical removal of part of the intestine
- Graft-versus-host disease
- Carcinoid syndrome
- Other causes of diarrhea:
- Bacterial infections
- Digestion and absorption issues
- Stress and anxiety
- Medication side effects
- Changes in gut bacteria
- Inflammation.
NoT all diarrhea is the same
The type of diarrhea someone has is important to understand to help determine the best treatment strategy.
- Secretory Diarrhea occurs when the intestinal cells increase the secretion of electrolytes or when the absorption of fluid is reduced.
- Osmotic Diarrhea happens when there are substances in the intestine that draw water into the bowel because they are poorly digested or absorbed.
- Altered gastrointestinal (GI) motility refers to when things move through the digestive system too quickly.
DEFINING DIARRHEA DURING CANCER
There is no definition for the number of bowel movements that are considered diarrhea, rather, it is a condition where you have more bowel movements than usual, and they become loose and watery. Diarrhea in the context of cancer is characterized by an increase in the frequency of bowel movements and the presence of loose or watery stools. The severity of diarrhea during cancer can be classified into different grades:
| Grade 1 | Increase of <4 stools/day or milk increase in ostomy output compared with baseline |
| Grade 2 | Increase of 4-6 Stools/day or moderate increase ostomy output compared with baseline; limiting instrumental activities of daily living |
| Grade 3 | Increase of 7+ stools/day over or severe increase in ostomy output compared with baseline; hospitalization indicated; limiting self-care activities of daily living |
| Grade 4 | Life-threatening consequences; urgent intervention indicated |
(Source: National Cancer Institute Common Terminology Criteria for Adverse Events v5.0)
Dietary strategies to help manage symptoms and stay nourished
Dietary changes can play a significant role in reducing the severity of diarrhea.
Hydrate. Diarrhea leads to losing fluids and essential electrolytes like sodium, potassium, magnesium, and chloride.
- Drink plenty of clear, room-temperature liquids.
- For each loose bowel movement, drink 1 cup (8oz) of liquid to replenish lost fluids.
- Replenish sodium with foods like broth, soups, crackers, or pretzels
- Replenish potassium with foods like bananas, applesauce, potatoes, or diluted fruit juices.
Take It Easy on The Gut. It’s best to avoid or limit foods that can worsen diarrhea or gas, such as:
- Greasy Foods
- Fried Foods
- Spicy Foods
- High Sugar Foods
- Caffeine
- Alcohol
- Whole grain bread or cereals
- Lactose-containing foods
- Beans and peas
- Cruciferous vegetables
- Sugar Alcohols (Xylitol, sorbitol, mannitol)
Slow It Down. When you have diarrhea, food moves through your gut more quickly, which can reduce the absorption of nutrients from what you eat. To make it easier for your body to get nourishment, consider the following tips:
- Instead of having large meals, eat multiple small snacks throughout the day. This reduces the amount your gut has to digest at once.
- Include pectin-rich foods like applesauce and bananas that can help firm up bowel movements.
- Choose foods that are “pre-processed” or easily digestible like soup or bone broth, oatmeal, cooked rice, and gelatin. Your inflamed and damaged gut is going to have a more difficult time digesting and absorbing food.
Not only can diarrhea can be a bothersome side effect, it can be dangerous and lead to treatment delays or dose reductions if it does not get under control. By effectively managing diarrhea, you can alleviate its symptoms, maintain your energy levels, prevent dehydration, restore electrolyte balance, and help your body absorb the essential nutrients it needs to support your overall well-being and optimize your cancer treatment outcomes.
If you need more one on one support in managing treatment induced side effects, apply to work with me.
