SABO Patient Information Leaflet - SCAN

SE Scotland Cancer Network
SABO Patient Information Leaflet
Bowel Problems?
Have you been having problems with your bowels? We want to
share some tips that other people have found useful. You may
find some ideas help and others don’t. Try them and let us know
how you get on.
What is SABO?
SABO stands for Sub Acute Bowel Obstruction. This happens when cancer sticks on the
outside lining of the bowel wall. Cancer can make the lining thickened and stiff so that it
does not stretch and push food along to the tail end the way it should. Food normally goes
through the hole in the middle of the gut (like passing through a long, hollow sausage) and it
stretches the outside lining as it passes.
Sometimes hard bulky food can struggle to get through the narrow areas where the outside
lining is thickened by cancer. It then gets stuck and the bowel above starts to push harder
and harder to get the food through. This gives symptoms of crampy tummy pain (colic).
The bowel above the narrowing can then become swollen and full of liquid. This gives
symptoms of bloating and gurgling noises. Eventually if the food cannot get through, the
bowel starts to push it the other way and you can then start to be sick/vomit.
Importantly in SABO some food still does get through although it can be a bit hit and miss.
This gives symptoms of ‘erratic’ bowels – sometimes constipation, sometimes diarrhoea.
Every person feels it differently and it can depend if the blockage is nearer the stomach or
the tail end. But there are some common symptoms which can include:
Common Symptoms:
Feeling bloated all the time
Lots of gurgling noises
Feeling full after only a few mouthfuls of food
Constipation or not passing very much wind from the tail end
‘Erratic bowels’ – sometimes constipation, sometimes diarrhoea which can be
unpredictable
Colicky abdominal pain that comes in waves (colic)
Nausea and sometimes vomiting large volumes of foul smelling fluid
Heartburn
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What might help?
• Laxatives
These are essential in managing your SABO. Although you may have episodes of
diarrhoea followed by constipation you will feel much more comfortable using laxatives to
have a more regular, loose motion every day (or preferably more than once a day).
o Movicol is one of the best but it can be a large volume to drink.
o Lactulose is a gentler alternative.
o Suppositories and sometimes enemas can also help get things on a more
even keel.
We tend to avoid laxatives that cause the guts to try to push harder (like senna, bisacodyl
or danthron) as these will make the colicky pains worse.
• Antisickness drugs
There are a lot of different drugs that can be used to control nausea or vomiting.
Sometimes it can be difficult to swallow these if you are feeling full up. Do let your
specialist know if you are struggling or if you cannot manage your tablets. Even
something as simple as changing to liquids instead of tablets can help but there are also
drugs you that dissolve in your mouth that may help.
If you take your tablets and then vomit them back up don’t be afraid to take another dose.
If you can see the tablet it has not done much good. As a rule of thumb, if you see it or if
you are sick within half an hour of taking your medicine, repeat the dose if you can.
If your bowels are not working at all well then swallowing even the best medicine and
being sick is not going to work and using a jag (an injection) will help. We often use a
special device called a subcutaneous pump that can give you the same as a jag only
over 24 hours every day. It can be filled up once a day by the district nurse. It is quite
small (about the size of mobile phone) and it is attached to a plastic needle that stays
under the skin in your upper arm. You can carry it about and no-one will know.
• Pain relief
There are many painkillers that will help with the colicky pain.
o Buscopan tablets are used for mild pain. These work best if they are taken
regularly rather than waiting for a bout of pain to arrive.
o Paracetamol again can be useful if used four times a day rather than just
when needed.
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We can prescribe much stronger pain killers but many of them can cause constipation as
a side effect and your laxatives may need to be increased.
o There are strong pain relieving patches, worn on the skin, called fentanyl,
which you do not need to swallow.
We can also put the pain killers in the pump described above so you do not have to
swallow them.
• Steroids
Short, sharp courses of steroids can help settle a bad bout of SABO. Steroids work by
calming down the swelling around the narrowed areas and allowing the food to go
through better. Talk to your specialist about having a 5 day course of oral steroids.
o Dexamethasone is often used as you can dissolve the tablets in a little liquid
to make them easy to swallow. If they are used in short, sharp courses there
are fewer side effects, like weight gain, but it can make your heartburn worse.
Try and take your steroids early in the day as they can keep you awake at night.
However they are best taken when you are least likely to vomit. If you are not able to
swallow, these may be given in a drip.
• Heartburn
This can make you miserable so don’t suffer in silence.
o Omeprazole and lansoprazole are very good antacid medicines that can help.
These may need to be taken twice a day.
• ‘Resting the gut’
If you are having a bad bout of SABO, it can sometimes help to give the gut a break.
This means taking fluids only for 24 hours. Remember to take sugary drinks as you
absorb much more water from them than just plain water.
If you are feeling rotten it can help to have 24 hours of a drip in hospital to completely rest
the gut. Why not talk to your nurse specialist or oncologist? Talk over what to do when
and who to call if things are not settling.
• Mouth care
When you are feeling or being sick your mouth can taste horrible. Take extra special
care with a mouth wash you like; ice cubes to suck can be great. It can be easy to get
oral thrush when you are run down so look for any white areas sticking to the inside lining
of your mouth. If you have this – there are special tablets and mouthwashes to use to
make things better.
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I have been told about a diet that can help – what is this?
Low Fibre Diet
This can sound strange; we are recommending cutting out a lot of things that you have been
told are good for you – but it works! The dietary advice which follows will give you some tips
but the basic idea is to cut out foods that will make your bowel motions big, hard and bulky.
These bulky stools find it much harder to pass through any area of narrowing. Liquidy stools
are your friend.
Practical tips about your diet
As well as following a Low Fibre Diet, here are some tips that can help.
• Eat small servings. You probably already do this. If your appetite is poor it may be
helpful to use a small plate.
• Eat frequently. Try the ‘grazing’ approach. ‘Little and often’ is best. 5 or 6 small meals
or snacks may work better than 3 meals a day.
• Choose softer foods they may be easier to manage.
• Avoid nuts, raw/dried fruits and vegetables including seeds, pips and skins.
• Keep up your fluids. High calorie, high protein drinks are the best e.g. Full cream milk,
milkshakes
• Choose a variety of foods from the low fibre food choices below. Experiment! A boring
diet is tedious. Food is meant to be a pleasure. Experiment with flavourings such as
herbs, onion salt, tomato puree, soy sauce, infused vegetable or olive oils.
• Take a multivitamin/mineral supplement as it can be hard to get all the necessary
vitamins and minerals if you are not managing a full range of foods.
• Your GP may be able to prescribe supplement drinks for you if your appetite is poor. Try
to take these in addition to your meals and snacks.
• Try reintroducing your favourite foods in small amounts. Half a strawberry is fine! You
are the best expert on your gut. Remember, above all, that these are only guidelines and
it is better for you to eat something. You will quickly find out which foods suit you best. If
you have a bout of SABO try and look at what may have brought it on.
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After a bout of SABO, as your symptoms improve, re-introduce foods into your diet one at a
time and in small amounts.
It may be useful to try the following steps as a guide;
1. Clear fluids - tea/coffee (no milk), fruit tea, cordial/squash, fruit juice (smooth),
Bovril/Oxo/Marmite drinks.
2. Free Fluids - milk, custard, soups (clear, consommé, cream).
3. Low Fibre diet - Gradually re-introduce low fibre foods from the list below. If you do
this you can often spot which foods upset you.
High Fibre Foods
(Limit these)
Bread & Rolls
Wholemeal, granary, rye.
Cereals
All Bran, Branflakes, Muesli, Porridge,
Weetabix, Shredded Wheat.
Low Fibre Alternatives
(Try to choose these)
Bread & Rolls
White or smooth textured. White pitta or
naan bread.
Cereals
Rice Krispies, Cornflakes, Special K, Ready
Brek, Strained porridge.
Pasta and Rice
Wild or brown rice, whole-wheat pasta.
Pasta and Rice
White rice, pasta, noodles, cous cous, rice
cakes.
Starchy foods
Wholemeal flour and flour products;
fruit/bran/wholemeal scones, flapjacks, fruit
cake, cakes with nuts e.g. carrot cake,
wholemeal biscuits e.g. digestive, oatcakes.
Starchy foods
White flour and flour products;
cornflour, plain/cheese/treacle soda scones,
sponge cake, pancakes, plain biscuits e.g.
cream crackers, rich tea, cream biscuits.
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High Fibre Foods
(Limit these)
Meat, Fish, Poultry & Eggs
Casseroles or stews with onions and
vegetables, chilli, curry. Tough meats,
sausages, burgers, haggis.
Fish with small bones e.g. herrings, sardines.
Pulses e.g. peas, baked beans, kidney
beans and lentils.
Low Fibre Alternatives
(Try to choose these)
Meat, Fish, Poultry & Eggs
Meat—any type including poultry and offal.
Choose well cooked/soft varieties.
Eggs.
Fish—all other varieties.
Tofu and Quorn.
Milk and Milk Products
Cheese, yoghurt and ice cream containing
fruit, nuts or cereals.
Fruit and Vegetables
Dried Fruit, nuts, skins and seeds. All fresh
fruit except those listed opposite.
Sweetcorn, onion, potato skins,
All raw vegetables and salads. All other
vegetables except those listed opposite.
Miscellaneous
Soups with vegetables or pulses.
Popcorn.
Coconut.
Toffee or chocolate containing dried fruit or
nuts.
Peanut butter.
Milk and Milk Products
Milk, cream, butter, cheese, ice cream,
yoghurt and milk puddings.
Fruit and Vegetables
Fruit or vegetable juice.
Soft tinned fruits e.g. peaches.
Stewed soft fruit e.g. apple.
Potato– mashed, boiled, roast, chips. Small
amounts of carrot, turnip, squash, beetroot,
cauliflower tops. These should be well
cooked.
Miscellaneous
Clear, strained or cream soups. Bouillon,
consommé.
Tea, coffee, squash, cordials, boiled sweets,
chocolate, fudge, toffee.
Seedless jam, rindless marmalade, honey,
syrup, smooth chocolate spread, lemon curd.
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What about surgery?
The peritoneal lining covers everything and you cannot remove it without removing the bowel
it is covering. Because it is often not just one area of the bowel that is narrowed surgery
often will not help. However, a CT scan taken after you drink some contrast liquid (a type of
dye) can help to see if only one area is affected. We can watch the dye going through your
gut. If there is just one area of narrowing your specialist will advise you of the benefits and
risks of surgery, or if a special plastic tube (called a stent) may help. Sometimes, if the
bowel is completely blocked, surgery can be used to bring out the bowel above the
narrowing. This is called a stoma.
However, most episodes of SABO are not so dramatic and there are tricks to try with both
medicines and diet. SABO often comes in ‘bouts’. You may be fine for a while and then
have several days of symptoms before things settle again.
The good news is – with time we find that most people can avoid really severe bouts and the
need to come into hospital. We want you to have the confidence to manage your own
symptoms with time. It can all seem too much at first but we are here to help. Please Ask!
Other information
Ask for the SCAN leaflet on ‘nourishing drinks’
Here are some other websites to look at for more tips and diet advice
http://www.bccancer.bc.ca/NR/rdonlyres/01B68B82-61CD-45A4-B71D-
37A5A1318453/9329/LowFibreFoodChoicesPartialBowelObstruction1.pdf
http://www.cancernorth.nhs.uk/livingwithcancer/Symptomsandsideeffects/Diarrhoea/Morelow
fibredietideas
http://www.christie.nhs.uk/patients/treatments/pmp/diet.aspx
Published: Sept 2009
Review date: Sept 2010
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