"Changes in bowel habit" PDF - Lymphoma Association

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Changes in bowel habit
Some people with lymphoma will notice a change in their bowel habit. Common
changes are diarrhoea and constipation, which can be distressing, especially if they
start to affect your daily life. You might also experience an increase in wind (flatulence),
which can make you feel embarrassed or uncomfortable.
In this information sheet we aim to answer some of the questions you might have
about changes in your bowel habit:
● What can cause a change in bowel habit?
● For each type of change (diarrhoea and constipation):
– what does it mean?
– what are the symptoms?
– how should I change my diet?
– is there anything else that might help me to cope?
– are there any drugs that may help?
● What can I do to reduce flatulence?
What can cause a change in bowel habit when you
have lymphoma?
Changes in bowel habit may be caused by the lymphoma itself, by chemotherapy
treatment or by radiotherapy treatment directed to the abdominal area, or can occur
as a side effect of taking other medicines. For example, constipation may be due to
some types of anti-sickness drugs or painkillers.
Sometimes diarrhoea can happen for other reasons, for example an infection. It is
important to report any diarrhoea to your doctor.
'…talking about bowel habits is not top of anyone’s list…'
Marilyn
If you have any concerns about changes in your bowel habit or about flatulence, do
speak with your hospital team, who will be able to advise you further.
Changes in your bowel habit are likely to be temporary and mild, but sometimes they
may be longer lasting or more severe.
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‘The changes in bowel habit (constipation) I have experienced have greatly affected
my life and even now, 3 years after completing treatment, I have problems.
It is difficult to get my GP to accept this is an ongoing problem that may not
necessarily be helped by the usual methods of extra fibre, etc’.
Jill
Diarrhoea
Normal bowel habits vary. You may be someone who goes more than once a day or
someone who goes once every 3 days. Knowing what is normal for you is important
when deciding if you have diarrhoea. If you have diarrhoea your doctor will ask you to
provide a sample for testing to find out if this has been caused by an infection.
What is meant by diarrhoea?
Generally, diarrhoea means one or all of the following:
● an increase in the number of bowel movements you have each day
● an increase in the amount (volume) of stools you pass in a day
● a change in the way your stools look – stools may be less firm and more watery.
What are the symptoms?
Possible symptoms of diarrhoea include:
● cramping pains in the abdomen (tummy)
● feeling nauseous (feeling sick)
● needing to get to the toilet urgently
● a bloated feeling in the abdomen
● feeling feverish
● a change in your usual bowel movements.
Coping with diarrhoea
If you experience diarrhoea, you may find the suggestions below helpful.
Changes to your diet
If your diarrhoea is caused by radiotherapy to your abdomen, making dietary changes
is unlikely to help. Always discuss your concerns with your radiotherapist (clinical
oncologist) or another member of your medical team before changing your diet.
Possible suggestions include:
● Drink extra fluids during the day to help replace the fluids lost by diarrhoea.
● Some drinks can stimulate the bowel and make diarrhoea worse. These include
fruit juices (such as orange juice), tea, coffee, milk and alcohol. Drinking plain water
can help.
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● Drinks that are particularly hot or cold can stimulate the bowel. Try taking drinks
when they have cooled a little, which will make them more tolerable.
● Smoking can also stimulate the bowel and is best avoided.
● Try eating five smaller meals a day.
● Foods that are high in fibre, such as raw fruit and vegetables, beans, nuts or
wholegrain cereals can make diarrhoea worse. Fatty, greasy or spicy foods, including
milk products may also cause this. Eating vegetables without their skin will make
them lower in fibre. Low-fibre foods include mashed potato, white rice, dry white
toast and bananas.
●
During episodes of diarrhoea the body can become low in an important mineral
called potassium. You might like to include bananas in your diet as they are a good
source of potassium and lower in fibre than some other fruits. Other sources of
potassium include potatoes, fish, bread, chicken, beef and turkey.
Looking after your skin
Diarrhoea can cause the skin around your anus to become sore. The following tips
might help:
●
●
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●
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Using toilet paper can be painful. Try using unscented toilet wipes instead. (Note: Most
baby wipes are not flushable, but you can buy toilet wipes which can be flushed away.)
Having a warm bath can help soothe pain and tenderness.
Pat the area dry with a soft towel after a bath or shower. Try not to rub.
Ask your medical team about soothing creams to apply. Your radiotherapy team will
advise you about creams if you are having radiotherapy.
To avoid additional irritation, avoid wearing tight or nylon underwear, tight trousers
and jeans.
Coping when you are out and about
Being away from familiar surroundings can be stressful and worrying if you have
diarrhoea. The following suggestions may help you feel more confident and prepared
when you are out and about:
● Try to avoid long train, bus and car journeys.
● Before you travel, try to plan ahead and know where you will be able to find toilets.
●
Carry a ‘Just can’t wait’ card when you are out and about and worrying about access
to toilets (for example the card produced by the Bladder and Bowel Foundation, see
page 8 for their contact details).
● Always have some spare clothes with you. Carrying a plastic bag is also helpful for
soiled clothes.
● You may feel more confident wearing a pad to protect your underwear.
● If you are worried about nasty smells, take a body spray or perfume with you to help
you to feel fresh.
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Coping at home
You will probably feel more confident and comfortable at home, but there are still
things you can do to make life easier:
● You may feel extremely tired when having diarrhoea. Your body loses a lot of fluid,
which will naturally make you feel weak. It is important to keep drinking to replace
the fluids you have lost to avoid dehydration.
● Remember to rest as much as you can. This is not always possible but asking family
or friends to help with chores might help you to recover more quickly.
● You may find the use of a bidet, if you have one, to be helpful.
● Protect your bed if you are worried about having an accident during the night.
Disposable waterproof bed pads are available from most supermarkets. You could
ask at your hospital for a supply (not all hospitals will be able to offer this).
● You may feel more confident with a commode by your bed, particularly if you are
unable to get to the toilet quickly. Ask your medical team if they can arrange to
provide a commode for you.
● If you often have accidents, speak with your medical team. They may be able to
change your medicines or perhaps give you antidiarrhoeal drugs.
Always keep your medical team informed. If you have had diarrhoea you need to
tell your doctor as you may have an infection which needs further investigation.
Drugs that can be prescribed by your doctor
The drugs used to help manage diarrhoea are generally divided into two groups:
● Anti-motility medicines help to reduce the number of bowel movements so you will
need to go to the toilet less often. An example is loperamide (Imodium ® ).
● Bulk-forming agents make the stools more solid. An example is methylcellulose
(Celevac ® ).
In addition, you may be prescribed a mineral powder that dissolves in water to help
rehydrate your body.
Constipation
As mentioned in the previous section about diarrhoea, knowing what is normal for you
is important. If you are worried about becoming constipated, discuss this with your
medical team.
Constipation can occur for a number of reasons. It can be caused by:
● some chemotherapy drugs
● the anti-sickness drugs often used with chemotherapy treatments
● painkilling drugs, especially those which are morphine-based.
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Constipation can also be worsened by:
● anxiety and depression
● being unable to eat or drink normally
● being less mobile because of feeling weak or unwell.
What is meant by constipation?
Generally, you have constipation if:
● you have difficulty and/or pain when opening your bowels (you may find you have to
strain a lot to pass a stool)
● your stools are hard and small, and difficult to pass
● you are opening your bowels less often than normal.
What are the symptoms?
Possible symptoms of constipation include:
● not feeling empty
● feeling bloated and sluggish
● loss of appetite
● a hard swollen stomach
● stomach-ache and cramps
● very liquid diarrhoea that you can’t control – this is called ‘overflow diarrhoea’
● change in your usual bowel movements
● fatigue
● feeling nauseous
● headaches.
Coping with constipation
You may be able to prevent or stop constipation by eating more fibre in your diet and
drinking plenty of fluids. You might get advice from your hospital dietitian to help you
plan a high-fibre diet.
Having difficulty passing stools can make you strain quite hard when you use the
toilet. It is important not to strain in order to prevent piles or damage to the delicate
skin around the back passage, which could lead to an infection.
Changes to your diet
Possible suggestions include:
● Drink plenty of fluids, both hot and cold drinks. Aim to drink at least 2 litres a day.
● Fruit juices, such as orange juice and prune juice, can act as laxatives. Some people
find drinking coffee can stimulate the bowel too.
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● Try to eat at the same time every day, which may help to make your bowel motions
more regular.
● Eat plenty of fibre in your diet. Good sources of fibre include:
– wholewheat breakfast cereals like Weetabix ® , Shredded Wheat ® or muesli
– wholemeal or granary breads
– brown rice and wholemeal pasta
– beans, pulses, lentils and oats.
● Try to eat a variety of fresh fruit and vegetables with their skins on for added fibre.
● Natural remedies such as figs, apricots, liquorice and prune juice may help.
Keep moving
● Although side effects from lymphoma and its treatments can make keeping active
more difficult, a little exercise, such as a gentle walk, may help to keep your stools
soft and regular.
● Gentle exercise is also known to increase energy levels.
Drugs that can be prescribed by your doctor
Keep your medical team informed if you have constipation that does not improve,
particularly if you have not opened your bowels for 3 days. Your constipation will be
easier to treat if you let your medical team know about it early on.
Constipation can be treated by:
● laxative drugs given by mouth in tablet, liquid or capsule form
● suppositories, which look like pellets and are inserted into the rectum (back passage).
If you are currently having chemotherapy or if you have a low white blood cell count
check with your doctor before using suppositories
● an enema, which is a liquid that is inserted into the rectum.
There are four groups of laxatives, which act in different ways:
● laxatives that increase the amount of fluid in the bowel and make stools softer and
easier to pass – an example of this type is lactulose (Duphalac ® , Lactugal ® )
● laxatives that change the content of the stool to trigger the bowel to move – an
example is methylcellulose (Celevac ® ), which can also be used to treat diarrhoea
● laxatives that soften the stools and make them easier to pass – an example of this
type is docusate sodium (Dioctyl ® , Docusol ® )
● laxatives that cause the bowel to move more, so pushing the stools down the colon
to the rectum ready to be passed – an example of this type is bisacodyl (Dulcolax ® ).
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Flatulence (passing wind)
Some people experience more flatulence during treatment. This is due to more gas
being created in the digestive system, which makes you pass wind more often than
usual. Although not a serious problem, this can be embarrassing or worrying.
What will make flatulence worse?
There are several things that can make flatulence worse, including:
● eating large quantities of high-fibre foods
● swallowing too much air while eating
● drinking gassy drinks, including beer
● smoking
● being lactose-intolerant.
What can I do to reduce flatulence?
It is not possible to stop flatulence altogether but there are a few things that you can
do to help control it:
● Avoid foods that make it worse, such as cabbage, sprouts, onions, beans and
cauliflower.
● Try to eat your food slowly and chew for longer. This will reduce the amount of air
that you swallow.
● Drink fluids slowly rather than gulping.
● You might try eating ginger, drinking peppermint tea (or your GP might prescribe
peppermint oil capsules), or taking charcoal tablets, which can absorb smells and
are available from most chemists.
● Try taking gentle exercise, especially walking, which may bring some relief.
If you have any concerns speak with your medical team, who will be able to advise
you further.
If you have another bowel condition
If you already have another bowel condition such as Crohn’s disease, ulcerative colitis
or you have haemorrhoids or an anal fissure you should contact your medical team for
advice before trying to treat constipation or diarrhoea yourself.
Acknowledgements
We are grateful to Teresa Groom and Veronica Lewis, Haematology Clinical Nurse
Specialists at West Suffolk Hospital in Bury St Edmunds, Suffolk for their assistance in
reviewing this information.
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Useful sources of further information about changes in bowel habit
Bladder and Bowel Foundation
SATRA Innovation Park
Rockingham Road
Kettering
Northamptonshire NN16 9JH
0845 345 0165 (Monday–Friday, office hours, voicemail out of hours)
info@bladderandbowelfoundation.org
www.bladderandbowelfoundation.org
CancerHelp
(part of Cancer Research UK)
0808 800 40 40 (Monday–Friday, 9am–5pm)
via website
http://cancerhelp.cancerresearchuk.org
Macmillan Cancer Support
89 Albert Embankment
London SE1 7UQ
0808 808 00 00 (Monday–Friday, 9am–8pm)
Order line for booklets 0800 500 800
via website
www.macmillan.org.uk
Patient.co.uk
This website has evidence based information for patients and health professionals on
a wide variety of medical and health topics.
www.patient.co.uk
References
British National Formulary (BNF) No. 64 (September 2012).
Corner J, Bailey C (eds). Cancer Nursing: care in context. 2nd edition. 2008. Blackwell
Publishing, Oxford.
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How we can help you
We provide:
● a free helpline providing information and emotional support 0808 808 5555 (9am–6pm
Mondays–Thursdays; 9am–5pm Fridays) or information@lymphomas.org.uk
● free information sheets and booklets about lymphoma
● a website with forums and a chatroom – www.lymphomas.org.uk
● the opportunity to be put in touch with others affected by lymphoma through our
buddy scheme
● a nationwide network of lymphoma support groups.
How you can help us
We continually strive to improve our information resources for people affected by lymphoma
and we would be interested in any feedback you might have on this article. Please visit
www.lymphomas.org.uk/feedback or email publications@lymphomas.org.uk
if you have any comments. Alternatively please phone our helpline on 0808 808 5555.
We make every effort to ensure that the information we provide is accurate but it
should not be relied upon to reflect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult
your doctor.
The Lymphoma Association cannot accept liability for any loss or damage resulting
from any inaccuracy in this information or third party information such as
information on websites which we link to. Please see
our website (www.lymphomas.org.uk) for more
information about how we produce our information.
© Lymphoma Association
PO Box 386, Aylesbury, Bucks, HP20 2GA
Registered charity no. 1068395
Produced 21.12.2012
Next revision due 21.12.2014
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