Bowel Cancer Australia
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Overview
Bowel cancer treatment can change how your bowels and digestion work, and some foods may cause discomfort. Common issues can include diarrhoea, wind, constipation, and difficulty controlling bowel or bladder movements.
Keeping a food diary, making small changes to what you eat, and staying hydrated can help manage symptoms. There are also treatments and support services that can help. Talk to your healthcare team about any new or worsening symptoms.
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Managing bowel changes
Treatment for bowel cancer can affect how your bowel and digestion work. Some people may also find that some foods cause discomfort. These changes can be difficult to adjust to. They usually improve over time, but issues may be ongoing and require specialised help.
If you experience problems, talk to your GP, specialist doctor, specialist nurse or dietitian. To find an accredited practising dietitian, visit Dietitians Australia and use the “find a dietitian” search tool.
Surgery for rectal cancer can lead to symptoms such as faecal incontinence, constipation or frequent bowel movements. This is known as low anterior resection syndrome (LARS), and it can last for months or years. If you have ongoing bowel effects after rectal surgery, talk to your surgeon. Ways to improve bowel function may include changing what you eat, taking medicines and having physiotherapy.
Incontinence
Incontinence is when you can’t control your bowel or bladder.
Faecal incontinence
After surgery or radiation therapy, the movement of waste through the large bowel can become faster. You may feel that you can’t wait when you need to go to the toilet (urgency), you need to go more often, or you have less control over bowel movements. Bowel surgery or radiation therapy may weaken the anus, making it difficult to hold on when you feel the need to empty your bowels, particularly if you have loose bowel movements (diarrhoea).
Urinary incontinence
This is when urine (wee or pee) leaks from your bladder without you being able to control it. Bladder control may change after surgery or radiation therapy. For example, radiation therapy can irritate the lining of your bladder, because the bladder is located near the large bowel. Some people find they need to urinate more often, need to go in a hurry or don’t fully empty the bladder.
While you may feel embarrassed if you have bowel or bladder changes, there are ways to manage the symptoms. Incontinence usually improves in a few months, but sometimes takes years. Talk to your treatment team about whether any bowel or bladder changes are likely to be permanent.
Ways to manage incontinence
- Talk to your surgeon or GP about available treatments. They may refer you to a continence nurse or physiotherapist, who can suggest exercises to strengthen your pelvic floor muscles.
- Call the National Continence Helpline on 1800 33 00 66 to talk to a continence nurse about continence aids, if needed.
- Find out the location of toilets near where you are. Visit The National Public Toilet Map or download the National Public Toilet Map app to your smartphone.
- The Australian Government’s Improving Bowel Function After Bowel Surgery booklet has helpful tips about managing bowel problems. Call 1800 33 00 66 to get a copy, or visit Continence Health Australia.
- Bowel Cancer Australia has Bowel Care Nurses and a nutritionist specially trained to help manage and improve bowel dysfunction from LARS or bowel cancer. Call 1800 727 336.
Radiation proctitis
Radiation to the pelvic area can affect the lining of the rectum, causing inflammation and swelling (known as radiation proctitis). This can lead to a range of side effects including diarrhoea and bleeding from the rectum, the need to empty the bowels urgently, and loss of control over the bowels (faecal incontinence).
These side effects may appear shortly after radiation therapy for rectal cancer, but are generally not an ongoing problem because the rectum is then removed during surgery.
Your treatment team will talk to you about the risk of developing radiation proctitis and ways to cope with bowel changes.
Diarrhoea
Diarrhoea is the frequent passing of loose, watery faeces (stools or poo). It can also cause abdominal cramping, wind and pain. Different types of treatment can cause diarrhoea:
Surgery – If you have had part of your bowel removed, your bowel movements may be looser than you were used to. This is because the bowel absorbs water to form faeces. With a shorter bowel, the faeces don’t form as solidly as before. This may be ongoing, but there are many ways of managing diarrhoea.
Radiation therapy – Diarrhoea is a common side effect of radiation therapy. It can take some weeks to settle down after treatment has finished. For a small number of people, diarrhoea is ongoing.
Drug therapies – Chemotherapy, immunotherapy and targeted therapy drugs can cause diarrhoea and nausea. These side effects will go away after treatment and you can gradually return to a normal diet.
Ways to manage diarrhoea
- Eat small frequent meals instead of 3 big ones. Try eating every 2 hours.
- Low-fibre foods may be easier to digest. Examples include bananas, white rice, white pasta, white bread, potatoes, white fish and steamed chicken without the skin.
- Limit foods that increase bowel activity, e.g. caffeine; alcohol; spicy, fatty or oily foods; high-sugar fluids such as juice and soft/fizzy drink; artificial sweeteners.
- Raw fruit and vegetables, wholegrain breads and cereals, or legumes (e.g. lentils, chickpeas) may make diarrhoea worse. If they do, you may want to cut back on these foods for a few days.
- Lactose in dairy foods may make diarrhoea worse. Try low-lactose or soy-based products instead.
- Talk to your treatment team about ways to control diarrhoea, such as using over-the-counter medicines and changing what you eat.
- Watch for warning signs of dehydration. These include a dry mouth, dark yellow urine, dizziness and confusion. If dehydration is left untreated, it can be dangerous.
- Drink plenty of water (about 6 glasses a day) to avoid becoming dehydrated. Consider having an oral rehydration solution, such as Hydralyte or Gastrolyte.
- If your anus becomes sore, clean the area with warm water and a soft cloth or soft/water wipes or anal cleansing wipes (e.g. Rectogesic). Ask your treatment team to recommend a cream. Taking a soothing bath may also help.
- Having diarrhoea can make you feel tired. Try to rest as much as possible and ask family or friends for help.
- Ask for a referral to a dietitian or physiotherapist who looks after bowel issues. If diarrhoea continues for a few days, see a doctor.
Wind (flatulence)
Many people who have treatment for bowel cancer find that it gives them wind (gas or farting). This especially happens after you have had surgery. However, it is usually temporary and improves over time.
Working out what foods cause wind and what you can eat without side effects may help – although foods can still affect people differently.
Ways to manage wind
- Try chewing charcoal tablets, eating natural yoghurt and drinking peppermint tea.
- Cut your food into small, bite-sized pieces.
- Chew your food slowly and thoroughly.
- When you have a drink, take small sips and don’t use a straw.
- Talk to your doctor about what types of light exercise you can do to relieve bloating and wind.
- Foods such as eggs, legumes (e.g. lentils and chickpeas), fizzy drinks, and sugar-free foods may increase gas. If they do, you may find it helpful to limit these foods.
- Try keeping a food and symptom diary to help identify foods that cause wind.
- Ask your doctor if there are any medicines that may be helpful to you.
Eating after treatment
Immediately after treatment – particularly surgery – you may be on a modified diet. What you are able to eat might depend on the type of surgery you’ve had, how much of your bowel was removed and whether you have a stoma.
During and after treatment, you may find that certain foods upset your bowel and cause diarrhoea or wind. Your health care team may suggest foods to avoid, but as foods can affect people differently, you will need to experiment to work out which foods cause problems for you. It is better to limit – not exclude – these foods in your diet, as you may find that what you can handle improves over time.
Keeping a diary of what you eat can help. Make a note of the foods that cause constipation, diarrhoea or wind. Your ability to handle different foods usually gets better with time but can take many months. When returning to your usual diet, introduce one food at a time. If something causes a problem, try it again in a few weeks to see if your response has improved. Share this information with the health care team as it can help them figure out how to manage any issues.
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National Bowel Cancer Screening Program
Australian Government
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