Diarrhea

• Chemotherapy and radiation often act on cells that are rapidly dividing, such as tumor cells.
• Cells in the lining of the intestines, hair follicles, mouth, and bone marrow are also rapidly dividing, so they can become damaged by the chemotherapy or radiation.
• Stress, antibiotics, some foods, and food supplements can cause diarrhea.
• Stool softeners and laxatives can also trigger diarrhea.

Importance of therapy-related diarrhea

• Can prevent the intestines from absorbing necessary nutrients and fluids.
• Can be mildly bothersome or can be severe, or even life threatening.
• Diarrhea may not go away if untreated; it may get much worse.
• Early notice and treatment will give you the best cancer care and best chance of benefit from chemotherapy.
• Talk with your nurse or doctor, and he or she will guide your treatment.

When to report your diarrhea

• Please do not be afraid or embarrassed to call your doctor or nurse at any time.
• If left untreated the diarrhea may not go away; in fact, it may get worse.
• Call your doctor or nurse if you notice any of the “Early Signs” described below.

Early signs

• Change in normal bowel habits
• more stools per day than before chemotherapy was started
• softer or loose stools, even mushy stools.
• Increased cramping or gas, or both.
• Pain or feeling weak.

What can happen if diarrhea is ignored?

• Diarrhea not treated correctly can become serious, even life threatening.
• Early therapy gives better results and can prevent hospitalization.
• Hospitalization may be required to restore fluid balance and nutrition.
• Early treatment can help you to receive the best benefit from your chemotherapy.

Other important changes to report

• Dehydration (fluid loss) caused by loss of water through stools, can cause

• dry mouth
• decreased urination or darker, yellower urine, or both
• dizziness or feeling light-headed
• weakness or fainting.

• Electrolyte imbalances—salt and potassium are not correctly balanced; leg cramps can be an early sign of this problem.
• Weight loss—loss of fluid and nutrients through frequent stools.
• Fever, together with diarrhea, can be a sign of infection. This is serious and needs to be reported immediately.
• Any signs should be reported, so your doctor can decide if you need to be examined or treated:

• increased body temperature
• chills, sweating, feeling flushed or hot
• unable to keep your body warm.

TREATMENT INSTRUCTIONS

CONTACTS:      		DOCTOR:			TELEPHONE:
                  	NURSE:			TELEPHONE:

MEDICATION:                                  	DOSE:

SPECIAL INSTRUCTIONS:
WHEN TO STOP TAKING MEDICATION:                                           .

Management of diarrhea—what to eat and drink

• Force fluids to replace those lost by diarrhea.
• Drink a variety of fluids, at least eight to 10 large glasses of liquids a day —

  • Water should be only part of the 8 to 10 glasses a day; it does not replace lost minerals
  • Drink slowly; drink small quantities often
  • Gatorade^®* is a good source of fluids and it helps to replace lost salt and potassium
  • Clear soup or broth can help to replace lost salt
  • Sodas are also good for replacing salt, but let them stand until fizz has decreased to help prevent more gas or bloating
  • 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
  • AVOID very hot or very cold beverages.

• Foods: Eat small meals often.
• A good choice of foods for diarrhea:

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 starch.

• When these foods are being well tolerated, then you can start adding other foods.

• Choose bland low-fiber foods
• Chicken-white meat without the skin
• Scrambled eggs
• Crackers, white bread, and pasta noodles without sauce
• Canned or cooked fruits without skins.

• Foods that can make diarrhea and cramping worse:

• Fatty, fried, greasy, or spicy foods that can cause more problems and discomfort
• High-fiber foods that can be troublesome; bran and some cereals; raw fruits and vegetables
• Dried fruits, beans, popcorn, and nuts
• Chocolate.

* Gatorade is a registered trademark of The Gatorade Company.

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 avoid problems.

© 1996 Pharmacia & Upjohn Company		USX 5987.00 August 1996