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Symptom Management

Important Information About Diarrhea


Contributors


Leonard B. Saltz, MD
Assistant Attending Physician, Gastrointestinal Oncology Service, Department of Solid Tumors, Memorial Sloan Kettering Cancer Center, New York, New York

Al B. Benson III, MD, FACP
Director, Clinical Investigations Program and Adult Oncology Program, Robert H. Lurie Cancer Center; Associate Professor of Medicine, Northwestern University Cancer Center, Chicago, Illinois

Lisa Stucky-Marshall, RN, MS
Gastrointestinal Oncology Advanced Practitioner, Northwestern Memorial Hospital, Chicago, Illinois

Diane Baiano, RN
Clinical Nurse Specialist, Memorial Sloan Kettering Cancer Center, New York, New York

Carolyn E. Byrnes, RPh
Medical Sciences Liaison, Pharmacia & Upjohn Company, Kalamazoo, Michigan

font=>Introduction

This booklet will help you understand some of the causes of diarrhea and ways to treat and manage this problem. Diarrhea is frequently a side effect of chemotherapy. This booklet will define diarrhea and discuss the importance of reporting diarrhea to your physician or nurse. Early treatment usually brings the best results. Treatment and diet suggestions are included to help ease the discomfort and lessen the severity of this side effect.

Chemotherapy

Chemotherapy involves special drugs that are used to treat cancer. Chemotherapy is given in the hope of killing the cancer cells. Along the way, however, they often have an effect on normal cells. This can lead to side effects from the drugs. Most chemotherapy, or anticancer drugs, act (work) when cells are actively dividing or reproducing. The cells in the body that are most likely to be damaged or disrupted by the chemotherapy are also those cells that are rapidly dividing. The cells in the bone marrow and intestines are particularly sensitive to this type of damage. The hair follicles are also affected for the same reason, leading to hair loss (alopecia) with some drugs.

Side Effects

Side effects of cancer therapy can be mildly annoying or can lead to a severe and life-threatening situation. To optimize your therapy you need to keep your doctor or nurse informed of any side effects you experience, even if they seem to be minor problems. Early recognition and treatment of problems can help provide you with the best cancer care and may minimize the chances of having to reduce or miss doses of chemotherapy.

What Is the Intestinal or Lower Digestive Tract?

The intestinal tract or the lower digestive tract is in the lower part of your abdomen, below your stomach. It is made up of the small and large intestines (bowels). The intestines help the body absorb needed nutrients and fluids and rid the body of substances that are not necessary.

The small and large intestines are very susceptible to effects from cancer drugs because the cells of the intestine are rapidly dividing. Chemotherapy can interfere with the normal growth of these cells, so they can't carry out their normal functions.

The cancer itself can also disrupt the normal function of the bowels. Tumors can make hormones or substances that can change the absorption and elimination patterns of the intestines. Surgeries can also cause permanent changes in bowel habits, creating a new "normal" bowel habit. Stress, antibiotics, and some foods or nutritional supplements can also cause diarrhea.

Fever can be present along with diarrhea. The combination of fever and diarrhea is serious, because it can be a sign of infection. Report this to your doctor or nurse immediately.

Diarrhea

Early Recognition and Treatment Is Important

Early notice and treatment of diarrhea will allow for dose adjustments that may be appropriate to optimize your cancer care. It is in your best interest to alert your doctor or nurse to any signs of diarrhea or fever.

Information your doctor or nurse may need to know:

These can all make you uncomfortable and can be a cause for medical concern. Diarrhea, if not managed promptly, can interfere with your cancer treatment schedule.

Laxatives, Stool Softeners, and Other Medicines

It is also important to inform your doctor of all medicines that you are taking before you start your cancer therapy. Remember to ask the doctor or nurse before you take any new drugs, even if they are not prescription drugs. Important over-the-counter medicines or nonprescription medicines to ask your doctor about are as follows:

Keep your health-care professional informed before you decide to take any new medicines, home remedies, or begin diets or other steps to change or manage your bowel movements.

Defining Diarrhea

Diarrhea can be loose or watery stools, or it can be just a change in the stool hardness from firm to soft, or even mushy. Stools do not have to be watery to be diarrhea. Frequency, as well as consistency of bowel movements can alert you to the beginnings of diarrhea. Diarrhea can be defined as more frequent bowel movements. If you usually have one or two movements a day and you start to have three, four, or more, then that can be diarrhea. Any change from your normal bowel habit needs to be reported and monitored.

This is very important information to share with your doctor or nurse as soon as possible.

Consider diarrhea to be any change in normal bowel habits other than constipation. Remember that surgery can alter your bowel habits, leading to a permanent change from your presurgical bowel habits. This becomes your new normal bowel habit. If bowel habits change as a result of your chemotherapy, it can be considered diarrhea.

If you have had surgery, your bowel habits might change after the surgery. Your new bowel habits will be what we refer to as your "normal bowel habit" throughout this booklet.

More stools in a day than before chemotherapy, increased cramping or gas, or both, can all be early signs of diarrhea.

What Happens If Diarrhea Is Ignored?

When diarrhea is not treated promptly and correctly, it can become serious, even life threatening. Dehydration (loss of body water) may occur. Dehydration is more likely to be severe if diarrhea occurs at the same time as vomiting because body fluids cannot be adequately replaced. You may have to be admitted to the hospital so that you can be given the fluids and nutrients that were lost because of the diarrhea.

Some of the symptoms of dehydration are

Prompt treatment of diarrhea helps to minimize serious complications and hospitalization, and it can reduce any delays in receiving further chemotherapy.

Reporting Your Diarrhea

Diarrhea may not go away if untreated. It may get much worse and limit your ability to receive more chemotherapy, which will not give you the best treatment for your cancer.

Do not be afraid or embarrassed to call your doctor or nurse, he or she will be eager to help you manage or stop your diarrhea or other chemotherapy side effects, such as vomiting that may worsen dehydration. It may be easier for you and your doctor and nurse to treat the diarrhea if you report it early. This will help you to be more comfortable and to get the most benefit from your cancer treatment.

Other Important Changes to Report

Fever and diarrhea together can be a sign of infection. This is serious and needs to be reported immediately so that treatment can begin as soon as possible.

Any signs of fever alone, such as these, should also be reported:

Treatment of Diarrhea

There are several effective drugs that your doctor can recommend for the treatment of your diarrhea. You should not take any diarrhea medicine if you don't have diarrhea never take it "just in case."

It is very important to take the drugs as they are prescribed by your doctor or nurse, even if they are over-the-counter drugs and have different instructions on the package. Follow only the directions from your doctor or nurse.

The medicine should even be taken during the night if you still have diarrhea. You should not change drugs and take another medicine without your doctor's advice.

Do not stop taking the medicine. Continue to take the drug recommended according to the doctor's instructions. Get specific instructions from your doctor or nurse on when to stop taking the drugs. If you have any questions, always call before stopping the medication.

Your Diarrhea Treatment Guidelines

TREATMENT INSTRUCTIONS:

PEOPLE TO CONTACT:

DOCTOR:

TELEPHONE:

NURSE:

TELEPHONE:

DIARRHEA MEDICATION:

DOSE:

SPECIAL INSTRUCTIONS:

WHEN TO STOP TAKING MEDICATION:

While Taking Medicine for Diarrhea

Keep track of stools and contact your doctor or nurse if diarrhea gets worse.

Any questions should be answered by your doctor or nurse, by contacting him or her at the phone numbers he or she has given.

Fever and diarrhea are a serious combination of side effects. Tell your doctor if you think you have a fever.

Suggestions for What to Eat and Drink While You Have Diarrhea

Liquids: Force yourself to drink fluids (drink even when you don't feel thirsty) to replace body water lost by diarrhea. Drink at least 8 to 10 large glasses of liquids a day. If you cannot keep fluids down because of vomiting, you should contact the doctor or nurse. If you can keep fluids down, drink a variety of clear liquids, not just water.

AVOID milk and dairy products, they can make diarrhea worse and should not be eaten for at least a week after the diarrhea has resolved. Temporary lactose intolerance can develop with diarrhea.

AVOID alcohol and coffee - even decaffeinated coffee can cause problems.

Foods: Eat frequent small meals. A good choice of foods for diarrhea follows:

B-bananas—to help replace lost nutrients

R-rice—easy to digest and is a binding starch

A-apple sauce—to provide sugars for energy and soluble (water-holding) fiber

T-toast—easy to tolerate and is a binding starc.

When these foods are being well tolerated, then you can start adding other foods. Choose bland low-fiber foods, such as

Some foods can make diarrhea and cramping worse and should be avoided. These include

Cigarette smoking should also be avoided.

As your diarrhea improves and you are feeling better, you can start adding other foods to your diet. Let your body be your guide and avoid the foods that cause the diarrhea to return. Reintroduce foods with caution to help avoid problems.

For additional information, check with your doctor, nurse, or nutritionist.


* Citrucel is a registered trademark of Lakeside Pharmaceuticals; Gatorade is a registered trademark of The Gatorade Company; Metamucil is a registered trademark of Procter & Gamble.

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© 1996 Pharmacia & Upjohn Company


USX 5687.00 August 1996

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