Coping with Diarrhea and Dehydration

Diarrhea is a common side effect experienced by many patients with cancer. It is caused by one of the following: increased intestinal secretions, decreased fluid absorption, excessive intestinal motility, or a combination of these.

The source of these disturbances may include the following:

•  Lactose intolerance

•  Bacterial infection

•  Damage to intestinal wall

•  Hormone-producing tumors

•  Inflammation or ulceration of the bowel

•  Surgery that has shortened the gut causing malabsorption
•  Pancreatic enzyme insufficiency
•  Chemotherapy
•  Radiation therapy to the lower abdomen
•  Medications

Diarrhea is generally described as abnormally frequent bowel movements that are more fluid than usual. Patients describe it based on their past and present experiences; therefore, what is normal for one person may be considered diarrhea to another.

People may experience different types of diarrhea. Clay colored stools are often a result of problems with or blockages of the biliary tract, which is the drainage system for the gallbladder, pancreas, and liver. Biliary tract obstructions are common for patients with pancreatic cancer.

Floating stools often occur as a result of malabsorption of nutrients or changes in the diet such as increased fiber. Malabsorption is common for patients with pancreatic cancer because the pancreas may not be able to produce or release enough pancreatic enzymes to aid in the digestion of food.

If a patient is experiencing diarrhea, a journal may be helpful to write down the onset, frequency, duration, stool consistency, and self-care measures taken to control it. This written record can then be shared with the patient's doctor in order to help devise a plan to manage it. Since diarrhea can cause dehydration, it may also be helpful to keep track of fluid intake.

One topic to discuss with the doctor may be the necessity of taking pancreatic enzyme replacement medications with meals. Pancreatic enzymes break down carbohydrates, proteins, and fats from food. Additional enzymes may be needed if the levels of enzymes produced naturally by the pancreas are insufficient due to illness and/or a procedure. The doctor will prescribe the type, dosage, and administration schedule based on individual need, symptoms, and quantity of food intake.

The following foods may exacerbate diarrhea:

•  Fatty, greasy, or fried foods including high fat meats or cheeses, whole or 2% milk, rich desserts, many fast foods, and foods with added oil, butter, margarine, sour cream, cream cheese, or salad dressing.

•  High intake of insoluble fiber food sources during occurrences of diarrhea. Foods such as whole grain breads/cereals, raw fruits with thick peels, raw vegetables, and nuts can increase intestinal motility .

•  Gas-forming foods, including vegetables in the cabbage or onion family, dried beans, corn, popcorn, and chewing gum. If carbonated beverages are used, it is suggested that they be left open for at least 10 minutes prior to drinking.

Watery diarrhea may occur after eating foods high in sugar, like rich desserts, or if symptoms of high blood sugar are present. Symptoms of high blood sugar include increased thirst and urination.

The following foods are less likely to exacerbate diarrhea:

•  Lower fat food choices. Fat-free or reduced fat products may relieve symptoms of gas, bloating, and diarrhea.

•  Gradually increase soluble fiber foods such as oat fiber and high-pectin foods like applesauce and bananas.

If the patient has or develops lactose intolerance, yogurt, buttermilk, dairy products with added lactase (Lactaid®), and plant based milk alternatives such as soy or rice milk may help. Limit regular milk or products made with regular milk.

Other supportive care techniques:

•  Plan to eat 5 - 6 small meals and snacks each day.
•  Talk to the patient's healthcare team including the doctor or registered dietitian about pancreatic enzymes or other anti-diarrhea medications that may be appropriate.
•  *Over-the-counter anti-diarrhea medicines:
  •  Loperamide: Slows down the time it takes food to travel through the intestinal tract (e.g., Imodium A-D® and Imodium®).
  •  Adsorbents and Absorbents: Adsorbents (e.g., Pepto-Bismol® and Kapectolin®) attract diarrhea-causing substances from the digestive tract. Absorbents (e.g., Metamucil® and Konsyl®) make stools more solid by adding bulk.
•  *Prescription anti-diarrhea medicines:
  •  Opioids: Slow down the time it takes food to travel through the intestinal tract (e.g., Lomotil® and tincture of opium).
  •  Anticholinergics: Relieve spasms and cramping (e.g., atropine, belladonna, and scopolamine).
  •  Somatostatin analogues: Reduce the secretion of extra fluid and help the body reabsorb valuable water and electrolytes. They also slow down the time it takes food to travel through the intestinal tract (e.g., Sandostatin®).
•  Drink plenty of fluids.

* Before starting the use of any medicines, talk to the patient's doctor to help decide which would be best.

Diarrhea can cause dehydration. Here are some suggestions on how to avoid dehydration:

•  Drink 48 – 64 ounces of mild, clear liquids throughout the day to replace fluid loss from diarrhea. Liquids are better tolerated at room temperature. Check with the doctor to see if sport drinks or electrolyte replacement drinks (e.g. Gatorade®, Pedialyte®, or Ceralyte70®) may be beneficial.
•  Avoid beverages that contain caffeine such as coffee, tea, and sodas.
•  Drink an additional cup of fluids for each loose bowel movement.
•  Replace lost sodium with broth, soup, crackers, pretzels, and sports drinks or electrolyte replacement drinks (e.g., Gatorade® or Pedialyte®).
•  Replace lost potassium by drinking fruit juices, sports drinks or electrolyte replacement drinks, or by eating peeled potatoes and bananas.