Diarrhea and Chemotherapy

The side effects of chemotherapy depend on the type of chemotherapy and the amount given. Anticipating and managing side effects can help to minimize them and provide the best possible experience.

Diarrhea and chemotherapy

Each person is different, so is his or her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team possible side effects of treatment before the treatment begins.

Chemotherapy can damage the cells lining the intestine. This, in turn, can cause diarrhea (watery or loose stools). Contact your healthcare provider if you have diarrhea that lasts for more than 24 hours, if you have more than 6  loose stools per day during a 48-hour period, and/or if you have pain and cramping that accompany the diarrhea. It is important that you replace the water and nutrients you have lost. Your healthcare provider may prescribe a medicine to control your symptoms. If symptoms persist, you may need fluid replacement intravenously (IV). It is possible to replace these IV fluids on an outpatient basis. When you are having chemotherapy, you should not take any over-the-counter medicines for diarrhea without first talking with your healthcare provider.

Some chemotherapy medicines, such as irinotecan, can cause rapid onset of diarrhea that needs immediate remedy. If that is the case, your healthcare provider will have given you specific instructions for how to respond to changes in bowel habits. In these circumstances, it is very important to follow your healthcare provider's instructions. 

How can I help control diarrhea?

If you have diarrhea, consider foods such as the following:

• Yogurt and cottage cheese

• White rice, noodles, and potatoes

• Farina and cream of wheat

• Eggs (cooked until the whites are solid, not fried)

• Smooth peanut butter

• White bread

• Canned, peeled fruits, and well-cooked vegetables

• Skinned chicken or turkey, lean beef, and fish (broiled or baked, not fried)

With diarrhea, try to avoid the following types of foods:

• Fatty and fried foods

• Raw vegetables

• Fruit seeds, skins, and stringy fibers

• Vegetables high in fiber, such as broccoli, corn, dried beans, cabbage, peas, and cauliflower

Some people need to avoid milk and dairy products when they have diarrhea. This is because they may not tolerate the lactose contained in these products.

In addition, consider the following information provided by the National Cancer Institute as ways to reduce the severity of your symptoms:

• Be sure to replace all fluids that you have lost by drinking plenty of water and other fluids, such as clear broth, sports drinks, or ginger ale. If you choose a carbonated beverage, let it sit for a while until it loses its carbonation.

• Eat 5 to 6 small meals throughout the day instead of three large meals.

• Diarrhea can cause you to lose potassium. Unless your healthcare provider has told you otherwise, try to eat potassium-rich foods, such as bananas, oranges, potatoes, and peach and apricot nectars.

• Ask your healthcare provider if he or she advises a clear liquid diet to give your bowels time to rest. But this kind of diet does not provide all of the nutrients you will need and should not be followed for more than 3 to 5 days.

• Choose foods that are low in fiber, such as:

  • White bread

  • White rice or noodles

  • Creamed cereals

  • Ripe bananas

  • Canned or cooked fruit without skins

  • Cottage cheese

  • Yogurt without seeds

  • Eggs

  • Mashed or baked potatoes without the skin

  • Pureed vegetables

  • Chicken or turkey without the skin

  • Fish

• Avoid high-fiber foods that may cause diarrhea and cramping. These include whole-grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn, and fresh and dried fruit. Other foods that may cause cramping and diarrhea include coffee and tea with caffeine; alcohol; sweets; and fried, greasy, or highly spiced foods.

• Avoid milk and milk products, including ice cream, as diary may make your symptoms worse.

• Keep the rectal area clean and dry, using a mild soap. If necessary, your healthcare provider may recommend an ointment or cream for irritated skin.

According to the American Cancer Society, patients should call their healthcare providers when they have: 

• Six or more loose bowel movements a day with no improvement in 2 days

• New stomach pain or cramps that lasts for 2 or more days

• Not passed urine for 12 hours or more

• Not had liquids for 24 hours or more

• Had a 5-pound or more weight loss after the diarrhea starts

• Have an oral temperature (temperature taken by mouth) of 100.5°F (38.1°C) or higher

• Had constipation for several days and then have liquid stool that oozes from the rectum

• Blood in the stool or around the rectum

• A swollen stomach that is a new symptom