Constipation, diarrhoea and flatulence
This information looks at what constipation, diarrhoea and flatulence (wind) are and ways to treat them.
Constipation is a stopping or slowing down of how often you pass a bowel motion (poo). It can also be passing small, hard bowel motions with difficulty. Constipation may cause stomach cramps, nausea, a swollen stomach, and wind. Sometimes there may be fluid leaking from your bottom (like diarrhoea). This could be due to leaking around a blocked bowel motion.
Several factors may contribute to the development of constipation, for example:
- eating and drinking less than usual
- eating less fibre than usual (eg wholegrain breads, fruits and vegetables)
- exercising less than usual
- some medications, especially pain-relievers and some chemotherapy can cause constipation
- sometimes the cancer itself, especially cancer in the stomach and bowel.
It is important that the causes of your constipation are correctly diagnosed. Contact your doctor or nurse if you have not had a normal bowel motion or they have changed or been less frequent.
If you have any nausea, vomiting or severe abdominal cramps, if there is bleeding from your bottom or on the toilet paper after a bowel movement, contact your doctor immediately.
Haemorrhoids (piles) or a split in the skin can cause fresh bleeding from the anal area and may be due to straining to pass a bowel motion. Tell your doctor if this is happening.
- Eat fresh and dried fruits. Dates, prunes, figs and apricots can be helpful. Drink prune juice (try it warmed).
- Slowly increase the amount of fibre (roughage) in your diet. Good sources of fibre include whole grain cereals and breads, brown rice, fresh fruit (kiwifruit and prunes are particularly helpful) and vegetables with skins on.
- If eating more fibre, it’s important to drink more fluid too.
Eat regular meals with high-fibre snacks between. Try some of this prune mix daily:
1 cup pureed apple
1 cup bran flakes
1/2 cup softened prunes
1 cup prune juice.
Puree all together using a food processor or blender and eat two to three tablespoons with breakfast daily.
- Use Kiwicrush (you can buy it from the frozen fruit section of your local supermarket).
- Make sure you drink plenty if you can. Aim to drink 8 cups of fluid every day (eg water, milk, soup and hot drinks).
- Drink caffeine in moderation or not at all.
- Get enough rest and eat at regular times in a relaxed atmosphere.
- Exercise as you are able. Even short walks will help with constipation.
- When you start any new medication or chemotherapy, check with your doctor if you need to take a laxative with it. A laxative is a medication that can soften your bowel motions and make it easier to go to the toilet. For most people who are taking an opioid, such as codeine or morphine, it will be necessary to take a laxative.
It is not advisable to take any over-the-counter laxatives or enemas without discussing it with your pharmacist, doctor or cancer nurse.
If changing your diet or increasing activity isn’t possible or doesn’t work, your doctor can prescribe a laxative.
There are different types:
- those that add bulk, for example, Metamucil, Benefiber, Isogel, Granocol and Normcol.
- those that stimulate bowel motions, for example, Senakot or Bisacodyl.
- those that soften bowel motions, for example, Coloxyl, Senna and Docusate.
- those that retain water or draw water into the bowel, which softens the motion, for example, Lactulose, Laxol and Lax-sachets.
Your doctor or nurse may suggest a suppository. A suppository is a small, smooth pallet made of wax and contains a laxative medication. This is inserted into your anus where the wax melts and releases the medication. There are suppositories that can lubricate and/or stimulate the bowel, for example, Dulcolax or glycerol.
Another way of treating severe or persistent constipation is to use an enema, a small tube of fluid containing a laxative. The contents of the tube are gently inserted into the bottom.
If you are prescribed a laxative, tell your doctor or nurse if it is not working. Laxatives do need to be taken regularly to be effective.
Diarrhoea is loose or liquid bowel motions and may come with stomach cramps, bloating, frequency or urgency (needing to go more often and having to get to the toilet quickly). People being treated for cancer may experience diarrhoea for a number of reasons:
- some medications (for example, antibiotics and some chemotherapy drugs, such as 5 Flurouracil [5FU], Capecitabine [Xeloda])
- changes in what you eat can cause diarrhoea in some people
- gastrointesinal infections caused by viruses, bacteria or protozoa
- sometimes the cancer itself, especially cancers of the stomach or bowel can cause diarrhoea
- diarrhoea may be the result of some surgical procedures, for example, surgery to the bowel.
Chemotherapy or radiation treatment may affect your bowels, talk to your doctor or dietician for more information and advice.
It is important that the reasons for your diarrhoea are correctly diagnosed. Contact your doctor or nurse for advice.
If you are having chemotherapy you need to make contact with your oncology department if you have more than six bowel motions in any 24 hours, or more than four if they are very runny or large motions.
DO NOT take any over-the-counter medications to treat diarrhoea without consulting your pharmacist, doctor or nurse.
- Ongoing diarrhoea can cause dehydration, so drink plenty of fluids to replace the water lost with thediarrhoea.
- Avoid drinks high in sugar as they can make diarrhoea worse (eg fruit juice and cola).
- While you have diarrhoea it is best to cut down on your fibre intake from fruit, vegetables and wholegrains.
- Avoid highly spiced foods and fizzy drinks. These can cause wind and stomach cramps.
- Eat frequent, small meals made from light, plain, non-fatty foods, such as white fish, poultry, eggs, (well cooked), white bread, pasta or rice. Eat your meals slowly.
- Have fruit stewed or tinned rather than dried or fresh.
- If your diarrhoea is due to infection, your doctor will prescribe the right medication. For other causes, they can prescribe diarrhoearelieving medications. Commonly used medicines include Lomotil, Imodium (Loperamide), Diastop and codeine phosphate. It is important to take medication as prescribed and tell your doctor or nurse if it does not work.
If you have ongoing problems with diarrhoea and are worried about leakage, talk to your nurse about the use of specially designed pants and pads.
Flatulence is excess wind or gas in the stomach and If changing your diet or increasing activity isn’t possible or doesn’t work, your doctor can prescribe a laxative.
bowel, ongoing and lasting bloating or belching, or passing wind. People being treated for cancer may experience wind for a number of reasons:
- changes in what you eat
- exercising less
- sometimes it is due to the cancer itself, for example, some cancers of the stomach and bowel
- the type of surgery you may have had to treat your cancer.
It is important that the reasons for your wind are correctly diagnosed – talk to your doctor or nurse.
The following tips may help:
- Eat and drink slowly. Take small mouthfuls and chew your food well.
- Avoid food that you think gives you wind. Beans, cabbage, onions and garlic may cause problems.
- Some people find drinking through a straw can cause wind.
- Treat constipation if present – talk to your doctor or nurse.
- Gentle exercise, especially walking, can be helpful.
- Drink peppermint tea. If you like, flavour it with lemon juice.
- Charcoal tablets, which are available from your chemist, may be helpful. They should not be taken long-term and can interfere with the absorption of some medications and nutrients. Speak with your doctor or pharmacist before trying this.
- If you still have problems with wind, talk to your doctor.