Diarrhea
Topics covered on this page:
What is cancer-related diarrhea?
Diarrhea is when you have three or more loose, watery stools (poos) in a day. You may have an urgent need to go to the bathroom that you cannot stop. Diarrhea is the opposite of constipation.
- How does it affect me? Diarrhea is common among cancer patients. It can be stressful if you do not know when you might need a bathroom. Remember that diarrhea can make you lose water and electrolytes (salts) that your body needs to work well. This can cause dehydration that can make you weak and can be very serious if not treated.
- Does it get better? You can help manage or stop your diarrhea with the self-management strategies listed in this factsheet. Your doctor can also prescribe medication for you that can help.
What causes diarrhea?
Cancer treatments can sometimes cause diarrhea or make you more likely to have it. It can also be caused by food poisoning or other medicines you are taking, like antibiotics. This list includes some—but not all—of the things that may cause diarrhea:
- Certain cancer treatments
- The cancer itself
- Some medicines you may use for side-effects from cancer treatment like anti-nausea medicines, laxatives
- Stress and anxiety
- Gastrointestinal (stomach) infections
What are the signs of diarrhea?
Typical signs of diarrhea include:
- More than 3 loose or watery poos per day.
- Dehydration: you may have dry mouth, thirst, less pee than usual.
- An urgent need to go to the bathroom to pass your poo.
- Gas, or flatulence.
- Bloating in your belly.
- Cramping in your belly.
- Sore skin around the bum area from going to the bathroom a lot.
When should I get help for my diarrhea?
You should talk to your oncologist, nurse, or pharmacist at your next appointment if your diarrhea is worrying you or you need help managing your diarrhea. (For tips on talking with your healthcare team see Talking to your healthcare professional about your symptoms or concerns). Your healthcare team may advise you to stop taking certain medications. Consider trying over-the-counter medications for diarrhea following the recommendations of your healthcare team.
Talk to someone in your healthcare team immediately if:
- You have more than six loose watery stools (poo) per day.
- You feel tired, weak or dizzy.
- You are vomiting as well as diarrhea in the same day.
- You cannot eat or are afraid to eat.
- You are losing weight.
Talk to someone in your healthcare team immediately or go to the emergency department if:
- You have chest pains or unusual heart beats.
- You have very little or very dark pee.
- You have a fever over 38.5ºC or 101.3ºF.
- You have blood in your diarrhea.
- You have intense abdominal pain.
- The diarrhea persists for more than 24 hours, despite having taken medication to help with diarrhea.
What can I do to help manage my diarrhea?
There are many strategies to help you manage your diarrhea and to keep it from getting worse. Learn to control diarrhea early on to help avoid dehydration, skin soreness and weight loss Here are some suggestions you can try:
- Keep a record of your bowel movements.
- Keep a record of what you are eating and drinking.
- Write down when you first noticed the diarrhea and if anything has helped.
- For more information see Symptom Diary.
Drinking more will help make up for the water you lose through your diarrhea. Try to drink an extra cup of liquid for every watery poo you have.
- Try to drink a lot of fluids. Aim for at least 1.5-2 litres of liquids every day, unless you have been advised that you have a fluid restriction. A good way to know if you are drinking enough is to look at the colour of your urine. It should be light yellow or almost clear.
- Sip small amounts of water, often, during the day.
- Try liquids other than water. Try juice, diluted sports drinks, soups or even Jell-O.
- If you like drinking juice, drink it with added water to get more liquids.
- Try ice chips or popsicles if you have trouble drinking.
- Ask your healthcare team about drinking oral hydration solutions to make sure you are replacing the salts that you lose with diarrhea—a mix of water, salt and sugar.
What to avoid drinking:
- Stay away from coffee and black or green tea because they can make your diarrhea worse.
- Avoid milk and dairy products (except for yoghurt and firm cheeses).
- Check with your healthcare team to find out if there any foods or drinks that you should not have because of the cancer or treatment.
- Try to eat 5-6 small meals during the day instead of a few big meals.
- Ask your oncologist or pivot nurse for a referral to a dietitian.
Foods to help reduce diarrhea:
- Remove all skins, peel and seeds from fruits and vegetables. Try peeled fruits or canned fruit.
- Try the BRAT diet: bananas, white rice, applesauce and white toast. These foods can help you get back to a normal diet.
- Eat cooked foods, not raw foods, like cooked vegetables.
- Try low fibre foods that are high in protein and calories like: plain or vanilla yogurt, cottage cheese, skinned chicken or turkey.
- Try starchy foods like white bread, white rice, white pasta, instant oatmeal.
Foods to avoid:
- Milk products (except yogourt and firm cheeses), greasy, fried, spicy or very sweet food.
- High fibre foods like whole grain breads, nuts, seeds, beans, or lentils.
- Corn, broccoli, cabbage, onion, garlic, lettuce, strawberries, raspberries, blueberries, and grapes.
In case of urgent needs when you are out, try the following strategies to help you feel more comfortable leaving home:
- Find out where the bathrooms are located where you are going.
- Bring a change of clothes in case of an accident.
- Wear throwaway absorbent underwear if you think an accident might happen.
- Eating can often trigger a bowel movement so plan enough time for a bowel movement around meals.
When you have diarrhea, the skin around your anus (opening to your bum) can get irritated and sore. Here are ways to help you look after a sore bum resulting from diarrhea:
- Sit in a warm bath for 10 to 15 minutes. Do not add bath oils or anything else to the water.
- Clean your bum gently with mild soap and water after a poo, or use baby wipes.
- Use a water-repellent ointment like petroleum jelly or zinc oxide. Check with your nurse, doctor or pharmacist to see if they recommend another ointment.
- Pat with toilet paper instead of wiping to limit chafing.
- Leave your bum open to the air as much as possible. Men and women can wear large, cotton boxer shorts!
⚠ Important information about cannabis
Some patients do use cannabis to reduce pain, help with relaxation or as a sleeping aid. However, the research is still unclear about the use of cannabis to manage cancer-related symptoms, including diarrhea. It is important to talk to your doctor before trying cannabis. For more information on what cancer patients should know about cannabis, go to: www.bccancer.ca/health-info/coping-with-cancer/medical-cannabis.
Resources
For more information on diarrhea, self-management strategies and support organizations, check out the resources below.
Acknowledgement of sources
The content of this document has been adapted from the following sources:
- BC Cancer. Symptom Management: Diarrhea. 2017.
- Canadian Cancer Society. Diarrhea. 2020.
- Cancer Care Manitoba. Diarrhea (loose or watery stool). 2010.
- BC Cancer. Symptom Management Guidelines: Diarrhea. 2010.
- Cancer Care Ontario. Diarrhea Symptoms in Adults with Cancer. 2012.
- Coping Together. Dealing with Constipation and Diarrhoea. 2013.
- Diarrhea. 2016.
- Quebec Cancer Foundation. Diarrhea. 2020.
- Cancer Care Ontario. How to Manage Your Diarrhea. 2016.
- Patient education: Acute diarrhea in adults (Beyond the Basics). 2020.
- Patient education: Diarrhea in adolescents and adults (The Basics). n.d.
- Diarrhoea in adult cancer patients: EMSO Clinical Practice Guidelines. 2018.
Healthcare professional endorsement
The content of this document has been reviewed and approved by a team of healthcare professionals and clinical experts.
Disclaimer
Please note that this fact sheet is not intended as a substitute for consultation with a healthcare professional. Rather, it was designed to complement interventions by your treating team. If you have questions about your health, or any medical issue, you should contact a healthcare professional right away. You should not delay seeking medical advice, or disregard professional medical advice, because of information in this fact sheet. Before beginning any health treatment, always consult your doctor. All care has been taken to ensure that the information contained in this document is accurate at the time of publication. e-IMPAQc is not responsible for any injury or damage to persons or property arising out of, or related to, any use of the fact sheet, or because of any errors or omissions.
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