Nausea, diarrhea and constipation

Nausea/vomiting
Diarrhea and constipation
Diarrhea and chemotherapy
How can I help control diarrhea?
Constipation and chemotherapy
What will help constipation?

Nausea/vomiting

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 for the person receiving chemotherapy.

What are the types of nausea and vomiting associated with chemotherapy?

As each person’s individual medical profile and diagnosis 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 any/all possible side effects of treatment before the treatment begins.

The following are four types of nausea and vomiting associated with chemotherapy to treat cancer:

Anticipatory nausea and vomiting – after receiving a few treatments, some patients feel nausea and begin vomiting in anticipation of the next treatment. The reaction is usually caused by something related to the treatment, like the sights and smells of the treatment area. Anti-nausea drugs do not always prevent anticipatory nausea and vomiting. Actions that calm or distract the person work more often. These actions may include guided imagery, hypnosis, relaxation, behavioral modification or other activities like video games.
Acute nausea and vomiting– the physical reaction that occurs within 24 hours of administration of the chemotherapy can be mild, moderate or severe. Additional drugs may be given to control the nausea and vomiting. Drugs (along with some of their brand names) that are commonly given alone or in combination to prevent or treat nausea and vomiting include the following:
- Prochloroperazine (Compazine and many other brand names).
- Haloperidol (Haldol).
- Metoclopramide (Octamide, Metoclopramide Intensol, Reglan).
- Ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet).
- Dexamethasone (Decadron and many other names), methylprednisolone (Medrol and many other names).
- Dronabinol (Marinol).
- Lorazepam (Ativan and many other names), midazolam (Versed), alprazolam (Xanax and many other names).
- Aprepitant (Emend)
Delayed nausea and vomiting – in some patients, nausea and vomiting may occur more than 24 hours after taking chemotherapy. This reaction is more common in patients receiving high doses of chemotherapy, patients who experienced acute nausea and vomiting, women, patients who drink little or no alcohol, and young patients. Drugs that are used for acute nausea and vomiting also can be used in delayed nausea and vomiting.
Nausea and vomiting in advanced cancer – in patients with advanced cancer, nausea and vomiting may become chronic — not related to chemotherapy. The nausea may be related to other drugs taken to relieve pain or depression, or it may be the direct result of a brain or colon tumor. People with advanced cancer also may experience constipation, abnormal levels of substances in the blood, dehydration and stomach ulcers — all conditions that can contribute to nausea and vomiting.

Diarrhea and constipation

Diarrhea and chemotherapy

Chemotherapy can damage the cells that line the intestine, which in turn, can cause diarrhea (watery or loose stools). Contact your physician or nurse if you have diarrhea that lasts for more than 24 hours 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 physician or nurse practitioner may prescribe a medication to control your symptoms and/or, if symptoms persist, you may need fluid replacement intravenously. It is possible to replace these fluids intravenously on an outpatient basis. When you are having chemotherapy, you should not take any over-the-counter medications for diarrhea without first consulting your cancer care team.

How can I help control diarrhea?

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

Yogurt and cottage cheese
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, 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 fluid, such as clear broth, sports drinks (Gatorade) or ginger ale. If you choose a carbonated beverage, let it sit for a while until it loses its carbonation.
Eat small meals throughout the day instead of three large meals.
Diarrhea can cause you to lose potassium. Unless your doctor has told you otherwise, eat potassium-rich foods such as bananas, oranges, potatoes, and peach and apricot nectars.
Ask your physician if he or she advises a clear liquid diet to give your bowels time to rest. However, this kind of diet does not provide all of the nutrients you will need and should not be followed for more than three to five days.
Choose foods that are low in fiber, such as the following:
- 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, tea with caffeine, alcohol, sweets, and fried, greasy or highly spiced foods.
Avoid milk and milk products, including ice cream, as diary may aggravate your symptoms.
Keep the rectal area clean and dry using a mild soap. If necessary, your physician may recommend an ointment or cream for irritated skin.

Constipation and chemotherapy

Chemotherapy can cause constipation or hard, infrequent stools that have stayed in the bowel too long. Constipation also can occur if you are less active or if your diet lacks adequate fluid or fiber. Call your physician or nurse practitioner if you have not had a bowel movement for more than a day or two. They may suggest taking a laxative or stool softener, but do not take these measures without first consulting your cancer care team, especially if your white blood cell count or platelets are low.

What will help constipation?

The following strategies may help in reducing the symptoms of constipation:

Be sure to drink plenty of fluids to help loosen the bowels. If you do not have mouth sores, try warm and hot fluids, including water, to help provide relief from constipation symptoms.
Consult your physician or nurse practitioner regarding your diet. He or she may advise you to increase your fiber intake. However, this should only be done under the direction of your cancer care team, as there are some types of cancer and certain side effects of treatment for which a high-fiber diet is not recommended. High-fiber foods include the following:
- Bran
- Whole-wheat breads and cereals
- Raw or cooked vegetables
- Fresh and dried fruit
- Nuts
- Popcorn
Be sure to exercise every day. You may want to try a more structured exercise program or simply go for a walk. Consult your cancer care team regarding the amount and type of exercise that is right for you.