Constipation

Some painkillers, anti-sickness medication, and chemotherapy drugs can cause constipation. Sometimes prescribed laxatives are needed.

Gentle exercise, in addition to ensuring that you drink enough fluid, can also help. Aim for six–eight glasses/mugs (1.5–2 litres) each day. Any drinks count except alcoholic drinks, which can dehydrate the body and may worsen constipation.

Caffeine, for example in tea, coffee and some fizzy drinks can sometimes have a mild laxative effect. Increasing the amount of fibre that you eat can also help with constipation. Inform your healthcare team if you remain constipated after trying these measures.

A food product is classed as high fibre if it contains 6g or more of fibre per 100g. If it contains at least 3g of fibre per 100g, it’s considered to be a source of fibre. You can find this out by looking at the nutritional information on food packaging. Whole foods like vegetables, fruit, pulses and wholegrains are often naturally high in fibre.

[Foods which often contain higher quantities of saturated fat and/or added sugar are shown in italics.]

Examples of high fibre foods include:

• Fruits, including dried fruit, avocados, and vegetables – unpeeled (but washed or cooked) where appropriate
• Beans e.g. butterbeans, baked, cannellini and kidney beans
• Pulses e.g. lentils and peas
• Wholegrain/wholemeal foods, such as wholegrain breakfast cereals, wholegrain crackers/crispbread, wholemeal bread/rice/pasta
• Oats and oatcakes
• Nuts
• Seeds e.g. brown or golden linseeds can help to soften stools and make them easier to pass. Try adding one tablespoon per day (either whole or ground) to breakfast cereal, porridge, yoghurt, soup, sauces or on salad.
• This can be increased gradually to two or three tablespoons a day as needed. Ensure that you drink a small glass (150ml) of fluid with each tablespoon taken.

Specialist advice should be sought from your healthcare team if you’re receiving treatment for a cancer that involves the bowel, and you’re experiencing difficulties with food.

Diarrhoea

Diarrhoea is a frequently experienced side-effect of cancer treatments. Chemotherapy and pelvic radiotherapy can affect the lining of the digestive system, leading to loose bowel motions. This is usually temporary.

Infections and certain medications such as antibiotics can also give you diarrhoea. It’s important to discover the cause of of it to ensure that it’s correctly treated or managed. Probiotics and/or anti-diarrhoeal medications should be discussed with your nurse/doctor.

If you have diarrhoea, it’s important that you drink additional fluid to replace the liquid you’ve lost and prevent dehydration. Opting for decaffeinated drinks may also help to avoid further stimulation of the bowel. Alcohol should also be avoided for this reason. It’s also sensible to reduce or avoid fatty, fried, spicy foods as these may make your diarrhoea worse.

For some people, short term changes to the amount or type of fibre within their diet can also help (See below for tips to reduce your soluble fibre intake), but if this doesn’t improve things, ask for further information and advice from your healthcare team.

If you’re experiencing severe diarrhoea or if diarrhoea persists more than a few weeks after your treatment finishes, it’s important to seek advice from your healthcare team.

Tenesmus

Tenesmus refers to cramping rectal pain, which results in the feeling that you need to have a bowel movement, even if you have recently had one.

It’s frequently experienced by people that have received brachytherapy (internal radiotherapy), and also radiotherapy to the bowel/pelvic area. Medical treatments can help to manage tenesmus, and some people may also find relief from adapting their diet to reduce the amount of roughage (insoluble fibre) that they eat.

Tips to reduce your insoluble fibre intake:

• Avoid seeds/nuts, instead choose smooth nut butters
• Avoid fruit with pips e.g. berries
• Avoid citrus fruits
• Avoid leaves e.g. lettuce, spinach and cabbages
• Avoid beans, pulses, peas, sweetcorn, onions and mushrooms
• Remove skin/peel from potatoes, vegetables and fruits
• Choose white starchy carbohydrates, rather than wholemeal/granary/seeded varieties:
  • White bread products/white sourdough
  • White pasta/rice/couscous
• Use smooth tomato sauces/puree or passata, rather than fresh or chopped/plum tinned tomatoes.

Ideally try to re-introduce fibre containing foods gradually as soon as your symptoms allow. Please discuss this with your healthcare team if you require further support.