Diarrhea – OnCare Cancer Center Diarrhea
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Diarrhea
Chemotherapy damages rapidly dividing cells. Cancer cells tend to divide rapidly and uncontrollably. However, some healthy cells also divide rapidly, such as those that line the interior of the digestive tract. Chemotherapy also damages these cells, leading to a disruption in the delicate fluid balance that they maintain. Specifically, absorption of fluid from the gastrointestinal (GI) tract back into the body is decreased, and secretion of fluid and electrolytes in the stool is increased. This causes watery bowel movements, the definition of diarrhea.
Why is it important to manage diarrhea? Diarrhea is not only an inconvenient side effect of cancer treatment, but it can also:
Diarrhea can be severe enough that you are unable to tolerate your prescribed chemotherapy treatments. Chemotherapy treatments are commonly delayed if diarrhea persists. A disruption or delay in treatment may diminish the effect of treatment.
What makes diarrhea worse? Some factors may make chemotherapy-related diarrhea worse. For example, damage to the intestines as a result of surgery or radiation may make the GI system more susceptible to irritation. Medications such as antibiotics, diabetes, irritable bowel syndrome, reduced pancreas function, and other conditions may also worsen diarrhea. If you have certain biochemical characteristics, you may be more sensitive to chemotherapy drugs.
How is diarrhea managed? Diet - Several modifications to diet will help reduce the discomfort of diarrhea. Food that irritates the GI system should be avoided, such as greasy, spicy, or fried food. You should also avoid milk and milk products because diarrhea may lead to a loss of the enzyme lactase, which breaks down lactose, the sugar found in milk, resulting in temporary lactose intolerance. Because of their high fiber content, vegetables tend to be difficult to digest and should be avoided during episodes of diarrhea. Vegetables, such as cabbage, brussel sprouts, and broccoli, can be particularly problematic. Your diet should be limited to simple, easy-to-digest food, then expanded as the diarrhea begins to subside. A diet consisting of bananas, rice, applesauce, toast (called the BRAT diet), and clear liquid is a good starting point. Eventually, pasta without sauce, white-meat chicken without skin, scrambled eggs, and other easily digested food can be added, as tolerated. Fluid intake - Staying hydrated is very important in the management of diarrhea. You must consume enough clear liquids to make up for the volume of fluid lost due to the diarrhea. This amount is in addition to the usual daily intake. You may need to take in 12 to 16 cups or more of fluid per day. In addition to plain water, you should include beverages that contain some sugar and electrolytes, such as broth or Gatorade. Replacement of fluids with plain water alone can lead to low levels of salt or calcium in the blood. These can be life-threatening conditions. Drug therapy - The first drug to be prescribed for chemotherapy-related diarrhea is usually Imodium® (loperamide). Loperamide slows the gastrointestinal system and reduces the amount of fluid lost in the stool. Loperamide is effective for managing mild to moderate diarrhea, though it may not work for severe diarrhea. It is an over-the-counter medication that is inexpensive and is available as a pill. If diarrhea continues and is foul-smelling, you may have a toxin in your intestinal tract called Clostridium difficile. If this is the case, you need to contact your doctor because you will need to discontinue the loperamide and begin an antibiotic.
Which chemotherapy drugs cause diarrhea? Some chemotherapy drugs are more prone to cause diarrhea. Diarrhea is particularly problematic for some drugs that are central to the management of colorectal cancer and cancers of the gastrointestinal tract, including the fluoropyrimidines and irinotecan. Drugs used to treat other cancers may also cause diarrhea, although to a lesser degree. The cancer treatments that have been reported to cause diarrhea in 30 percent or more of patients are:
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