Dysfunctional bowel movements, whether diarrhoea or constipation, can be inconvenient at best and painful at worst. It is common for people with advanced cancer to suffer from one of these, or both at different times.

Constipation is defined as the passage of small, hard stools infrequently and with difficulty. It can be a result of the cancer itself and is not helped by inactivity, dehydration, poor nutrition or medications such as morphine. The discomfort of constipation can be distressing not only for the person who has it, but for caregivers, who often feel powerless to help.

Diarrhoea is defined as the passage of frequent loose stools with urgency (ie. more than three loose stools within a 24-hour period). Medications, chemotherapy, a lack of fibre (especially if you are having trouble digesting food), conditions such as radiation enteritis (swelling of the small intestine from ongoing radiation therapy) and anxiety can all contribute to this problem.

Urinary incontinence, or a loss of bladder control, may also be a problem, particularly for people who have had major surgery for prostate and colorectal cancers. Many people with incontinence find it is necessary to use continence products such as pads, pants, catheters, or bedding protection to manage their condition.

What may help

Talk to your Doctor

Your doctors and nurses should be able to suggest appropriate medications. If you are making an appointment with your doctor, ask for a long consultation so you can explain the problem without feeling rushed. Movicol, for instance, may be prescribed for constipation if you are taking opioid pain medications (eg. codeine or morphine).

Write down what you want to tell you doctor:

  • What is your usual bowel movement pattern?
  • What is your current bowel problem? How often does it occur? Have you experienced any bowel problems before? You may find it useful to note down the date and time you have had bowel problems.
  • When did constipation, diarrhoea, or urinary incontinence start? Did you identify a provoking factor (eg. types of food or drinks)?
  • What have you tried to relieve constipation, diarrhoea, or urinary incontinence?
  • The amount and type of fluid consumed and the type of diet generally consumed.

You may also like to write down a few questions to ask your health professionals such as:

  • What is causing these bowel problems?
  • When is it likely to get better or worse?
  • What can be done for bowel problems?

If you are prescribed medicine to help you with your bowel problems ask:

  • How long will it take to work?
  • How often should I take it?
  • What should I do if I continue to experience bowel problems?
  • Are there other options if the medication doesn’t work?
  • What are the possible side-effects of the medication?
  • How can the side-effects be managed?
  • Who will I keep seeing about my bowel problems?

If diarrhoea is the problem, your doctor may be able to prescribe anti-spasmodic medications.

Some medications can also help to tighten, or in some cases relax, muscles around the bladder to help counter incontinence. In worse cases, a temporary catheter may be preferable to living with the unease of an unreliable bladder.

Tips

  • Mix Movicol in fruit juice to improve taste. Sip it over an hour if you have difficulty swallowing fluids.
  • When anti-nausea drugs cause constipation after chemotherapy try 20 drops of Duralax with a cup of tea on the morning of treatment and the day after.

Changes in diet

Simple things included in your daily routine can help prevent constipation. Try drinking at least six glasses of water a day. A warm drink first thing in the morning may help. Eat plenty of fibre-rich foods such as wholemeal bread and high-fibre cereals, fruit and vegetables. Adding some boiled prunes into your diet may help. Snack on high-fibre food, such as fruit and nut mixes, sesame and nut bars and wholemeal biscuits.

If your dietary restrictions allow it, this Get Up and Go Cookies recipe (117kb pdf) may help with constipation.

If diarrhoea is the problem, the following suggestions may help:

  • Eating smaller meals more frequently (if your appetite allows) may take some of the pressure off your bowel. Try to eat three small meals and three snacks each day.
  • Beware of dairy products, alcohol, and spicy or fatty foods.
  • Avoid skins, pips and seeds from fruit and vegetables, whole grain bread, bran-based and muesli breakfast cereals, nuts and legumes such as lentils, dried beans, dried peas and baked beans.
  • If you have gas or cramping, avoid foods that can increase gas production, such as dried peas and beans, broccoli, cabbage, cauliflower, onions, brussel sprouts, carbonated beverages, beer and chewing gum.

For mild diarrhoea, clear fluids and the BRAT (banana, rice, apples and toast) diet are often recommended. Other foods to choose from include soft, well-cooked peeled vegetables and fruits or canned fruits, white bread and pasta, cornflakes, rice-based breakfast cereals, well-cooked rolled oats and semolina, and lean meat, fish, chicken, eggs and dairy products.

Caffeine, alcohol and other diuretic substances are not great if you have urinary incontinence, because they increase the amount of fluid there is to leak and the rate at which these are eliminated. However, you should still continue to drink water, as reducing your fluid intake can make bladder problems worse as it concentrates the urine and irritates the bladder.

Exercise

Exercise can also help with constipation – be as active as you can be, but do not exceed your physical abilities. Walking 15-20 minutes once or twice a day or 30-60 minutes daily or 3 to 5 times per week is typically recommended. If you are unable to walk or are restricted to bed, exercises such as pelvic tilt, trunk rotation and single leg lifts are recommended.

For incontinence, some people find Kegel exercises, designed to strengthen your pelvic muscles, and bladder training, which encourages people to extend the time between urination, helpful in controlling urinary incontinence. However, these are specific exercises and programs and you should ask your doctor, oncologist, physiotherapist or nurse if these are right for you.

Toileting and Privacy

If there is a time you usually feel like going to the toilet, try to be in a place where you can relax at that time each day. For people restricted to using bed pans or needing help to go to the toilet, embarrassment may cause constipation. It helps to create an environment that is as private and relaxed as possible.

A squat position can facilitate the defecation process. If you are unable to use the toilet (eg. bed-bound), the squat position can be stimulated by lying on the side and bending the knees and moving the legs toward the abdomen.

The Commonwealth Department of Health and Ageing provides a National Public Toilet Map as part of its National Continence Management Strategy. This may be useful when planning excursions.

Diarrhoea also comes with its share of embarrassment, of course, and it can make it easier if those around you understand that you may have urgent needs and can be discreet about helping you. This could mean identifying the nearest toilets and helping you get to them quickly. Try to make sure that some sort of toilet facility is always in reach. Carry damp wipes and a change of clothes if you are out.

For more information

  • More information about Kegel Exercises and other strategies to maintain bladder and bowel health can be found on the Continence Foundation of Australia website
  • You can also call the National Continence Helpline 1800 330 066 (free call) for information and advice from continence nurse advisors
  • Talk to your Doctor or nurse regarding a referral to a continence clinic or call the National Continence Helpline 1800 330 066 (free call)
  • to know which continence services are closest to you
  • The Continence Foundation of Australia also offers information about funding schemes to help you pay for continence products (eg. pads) call the National Continence Helpline 1800 330 066 (free call) for more information.

Life, Hope & Reality was developed and written by Afaf Girgis, Claire Johnson, and Sylvie Lambert with funding from the NHMRC and Cancer Council NSW.

Last updated 30 August 2015