Diarrhea

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. Often, health professionals characterize diarrhea as 4 or more loose stools per day. It is a common side effect experienced by many patients with cancer. 

Diarrhea may be caused by:

• lactose intolerance
• bacterial infection
• damage to intestinal wall
• hormone-producing tumors (including certain types of pancreatic neuroendocrine 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
• certain medications

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

Floating stools often result from poor absorption 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 proper food digestion.

If a patient experiences diarrhea, a journal may be helpful to track the onset, frequency, duration, stool consistency and self-care measures taken to control it. It is helpful to share this written record with the doctor or dietitian to help devise a plan to manage the diarrhea. Since diarrhea can cause dehydration, it may also be helpful to keep track of fluid intake.

Taking pancreatic enzyme replacement medications with meals is a topic to discuss with the doctor. Pancreatic enzymes break down carbohydrates, proteins and fats from food. If the levels of enzymes produced naturally by the pancreas are insufficient due to the cancer itself, surgery or other treatments, additional enzymes may be needed. The doctor will prescribe the type, dosage and administration schedule based on individual need, symptoms and quantity of food intake. Before starting the use of any medicines, talk to the doctor.

Regardless of the cause of diarrhea, the following diet modifications may help decrease the volume and frequency of stools.

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 make foods move faster through the intestines.
• Gas-forming foods, including vegetables in the cabbage or onion family, dried beans, corn, popcorn and chewing gum.  If carbonated beverages are used, leaving them open for at least 10 minutes prior to drinking may help reduce.
• Foods high in sugar may cause diarrhea due to dumping syndrome. The symptoms of dumping syndrome include watery diarrhea or feelings of low blood sugar that occur within 30 minutes to 2 hours after eating high-sugar foods. Symptoms of low blood sugar include flushing, faintness and sweating.
• Hot liquids.
• Products made with regular milk if lactose intolerance is present or develops.

• Lower fat food choices.  Fat-free or reduced fat products may relieve symptoms of gas, bloating and diarrhea.
• Soluble fiber foods, such as oat fiber and high-pectin foods like applesauce and bananas, can help thicken stools.
• If lactose intolerance is present or develops, it may help to use plant based milk alternatives, such as soy or rice milk, or dairy products with added lactase (Lactaid®). Lactaid® Fast Act caplets or chewable tablets can also be taken with dairy products instead of milk alternatives.
  

• Plan to eat 5-6 small meals and snacks each day.
• Talk to the healthcare team including the doctor or registered dietitian about pancreatic enzymes or other anti-diarrhea medications that may be appropriate. 
• Drink plenty of fluids.
• 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: Attract diarrhea-causing substances from the digestive tract (e.g., Pepto-Bismol® and Kapectolin®).
• Absorbents: Make stools more solid by adding bulk (e.g., Metamucil®, Benefiber® and Konsyl®).
• 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®).
• The use of probiotics appears helpful in improving tolerance of and support for treatment and radiation-related diarrhea. Further research is needed to confirm the effects of probiotics when used in patients with pancreatic cancer. Sources of probiotics include foods such as yogurt, kefir, buttermilk, tempeh and sauerkraut, therapeutic foods such as DanActive™, Activia™ and dietary supplements such as Culturelle® and Florastor®.

Diarrhea and Dehydration

Diarrhea can cause dehydration. Dehydration results in the loss of fluids and electrolytes, including sodium and potassium, from the body.

Here are some suggestions 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. 
• Avoid beverages that contain caffeine such as coffee, tea and sodas. 
• Drink an additional cup of fluids for each loose bowel movement.
• Check with the doctor to see if sports drinks or electrolyte replacement drinks (e.g., Gatorade®, G2®, Pedialyte® or Ceralyte70®) may be beneficial.
• Replace lost sodium with slightly warm broth or soup, crackers, pretzels, and sports drinks or electrolyte replacement drinks.
• Replace lost potassium by drinking fruit juices, sports drinks or electrolyte replacement drinks, or by eating peeled potatoes and bananas.

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only.  The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment.  If you are ill, or suspect that you are ill, see a doctor immediately!  The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site.  110913