Understanding the Problem

Chemotherapy and radiation therapy are given in the hope of killing the cancer cells. These therapies may have an effect on other normal cells of the body, especially those that are actively dividing or reproducing. The cells that line the gastrointestinal tract (GI tract) are actively dividing and are therefore very sensitive to the toxic effects of the chemotherapy and radiation treatments. This can result in diarrhea, cramps, nausea, and other problems with the intestines.

Having diarrhea can also be very upsetting. Losing these fluids adds to fatigue and feeling "washed out.” Diarrhea may not go away on its own and may become very serious if it causes you to become dehydrated. Diarrhea is defined as more than three watery bowel movements in 24 hours. Let your health care provider know if you are having diarrhea. If medication is ordered, obtain it right away and take it as directed.

Increase the amount of liquid you drink to help replace the loss of liquids from the diarrhea. Eat a bland diet and include those foods that thicken the bowel movement such as rice, potatoes, pasta, bread, bananas, applesauce, and peanut butter. Avoid alcohol and drinks with caffeine.

Call your health care provider right away if you have any of the following:

• Fever greater than 101° F, sweating, or chills
• Blood in stools
• Inability to drink liquids
• Fainting, feeling generally weaker, or feeling light-headed when you stand
• New or worse abdominal cramping pain, or gas
• Urinating less frequently, dark or strong smelling urine
• Diarrhea that continues or worsens despite treatment

Increasing Your Comfort

Diarrhea and abdominal cramps may cause the abdomen to become sore. The person with cancer may also feel worn out and weak from the diarrhea. Skin around the rectal area may become sore. Here are some tips to increase your comfort.

• Keep the rectal area clean and dry. After diarrhea, cleanse the area with warm water or a no-rinse perineal cleanser. These cleansers are available in drug stores or at medical supply stores.
• If you are receiving radiation to the rectal or perineal area, check with your health care provider in the radiation department for skin care instructions. If you are not receiving radiation to that area but have soreness from diarrhea, apply a skin-protective ointment after each bowel movement. Zinc oxide is inexpensive and effective. Others are available at drug stores and medical supply stores.

Understanding Medications for Diarrhea

General Instructions

• Do not change medicines or take other medicines without your medical team's advice
• Medications may be taken after each watery bowel movement even during the night
• Antacids such as Mylanta® and Maalox often make diarrhea worse. Amphojel® or Alternagel® usually do not make diarrhea worse
• If you have questions, always call before starting or stopping a medication

Most Common Medications for Diarrhea
Your medical team will instruct you on which ones to take and how to take them. Do not mix medicines without contacting your medical team. Remember to call your medical team before starting, stopping, or changing any medicine

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your healthcare team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.

11/05