What is radiation-related diarrhea?

Diarrhea is defined as more than two loose or watery stools per day. It can be caused by radiation over your bowels. These loose or watery stools may start two weeks after your treatment begins, continue throughout the treatment course and gradually disappear after you have completed treatment. If left untreated, diarrhea can cause weakness, weight loss, skin problems, and poor nutrition.

How do people describe radiation-related diarrhea?

People sometimes have difficulty describing diarrhea, but usually use terms like "loose" and watery". They describe the number of times they have to use the bathroom within a period of time and sometimes express fear of not making it to the bathroom on time.

What happens when you experience radiation-related diarrhea? Radiation-related diarrhea can be mild (a few loose bowel movements per day) to severe (12-15 loose bowel movements per day). Skin irritation and soreness around the rectum can also result from diarrhea. If not treated, diarrhea can cause you t become dehydrated, fatigued, and can interfere with your daily activities.

What causes radiation-related diarrhea?

Radiation to the abdomen or pelvic area increases bowel activity, thus causing diarrhea.

How do people cope with radiation-related diarrhea?

• Avoid eating foods high in fiber, fatty foods, rich desserts, and other foods that increase bowel movements or gas such as hot peppers, drinks with caffeine, and alcohol.
• Follow a low-fiber/low roughage diet.
• Increase your intake of liquids to 6 8-ounce glasses (about 1.4 liters) per day (unless told not to do so by your doctor).
• Use Imodium, an over-the-counter medicine for loose stools, as directed on the box. If over-the-counter medicines do not work, please let your doctor or nurse know since there are other medicines that can be prescribed.
• Keep a record of your bowel movements over the course of a week. A sample recording sheet follows this handout.
• Do Not apply any Vaseline to the radiation area. You will be advised on proper skin care following radiation treatment.
• Talk to your doctor or nurse. Occasionally people have rectal discomfort, such as itching, burning, or pain during a bowel movement. If this occurs, medication can be ordered to relieve these symptoms.

What can family or significant others do to help with radiation-related diarrhea?

Family members can help by learning about the problem and assisting with purchasing and preparation of foods that will help decrease diarrhea. Partners or significant others can be helpful when deciding to call your doctor or nurse.

How can I talk with my partner about my radiation-related diarrhea?

• Be open and honest with your partner.
• Fully and calmly discuss your problem as well as your thoughts and feelings.
• Ask for your partner's thoughts, feelings, and ideas.
• Brainstorm possible solutions. Post your final plan.

What symptoms should you report to the nurse?

Let your doctor or nurse know if these measures do not control your diarrhea. In addition you should let them know if:

• You have bloody or hard stools.
• You have a temperature of 100.50F (38C) or greater.
• You are unable to keep down liquids.
• You become dizzy.
• You notice your urine becoming dark yellow in color.

Who can I call to get more information?

• Contact your health care provider.
• Contact the American Cancer Society at http://www.cancer.org/.

Breads and Cereal Breads

enriched white, Vienna, French, light rye without seeds, melba toast, zwieback, corn Muffins: plain muffins, corn muffins, plain pancakes and waffles Cereals: refined cereals such as oatmeal, buckwheat, cream of wheat or rice, corn flakes, Rice Krispies, Rice Chex, Cheerios, etc. Pasta/rice: white rice, brown rice, enriched noodles, macaroni, spaghetti, most pastas

Fruits and Vegetables

Fresh Fruit/Frozen Fruit: Banana Canned Fruit: Applesauce, apricots, cherries, peaches, pears, pineapple, mandarin oranges, orange/grapefruit sections, jellies Dried Fruits: None Fruit/Vegetable Juices: Fruit juices without pulp (except prune), vegetable juices without pulp, citrus juices in moderation Fresh Vegetables/Frozen Vegetables: WELL-COOKED green beans, beet, squash, pumpkin, white/red potatoes without skin, sweet potatoes without skin, carrots, spinach, asparagus, strained tomatoes, celery, mushrooms Canned Vegetables: Green beans, peas, beets, squash, pumpkin, tomato sauce, tomato paste, tomato puree, potatoes, sweet potatoes, spinach, carrots, asparagus, strained tomatoes, mushrooms

Fats

Margarine, sour cream, butter, gravy, mayonnaise, dressing, bacon, sparingly

Beverages

Water, weak or decaffeinated tea, ginger ale, 7 up or clear soft drinks, decaffeinated colas, Gatorade, sport drinks

Meat/Other Protein

Stewed, boiled, baked, barbecued, well-trimmed, low-fat meats, non-fried eggs, low-fat cottage cheese, cream cheese, processed skim-milk cheese, part-skim mozzarella and ricotta, farmer cheese, string cheese, Parmesan, and any other cheese with 5g of fat or less per serving (read label)

Soups

Broth-based soups with allowed foods, cream-based soups made with low-fat milk with allowed foods (e.g., chicken noodle, cream of asparagus soup made with low-fat milk)

Desserts

Popsicles, sherbet, water, ice, jello, angel food cake, vanilla wafers, ginger snaps, plain cake, hard candy, jelly beans, pudding made with low-fat milk, arrowroot cookies, frozen yogurt, ice milk, low-fat frozen desserts, honey, syrup

Milk

2 cups or the equivalent per day of skim milk, low-fat milk, powdered milk, buttermilk, evaporated milk, low-fat yogurt, low-fat chocolate milk, ice milk, frozen yogurt, lowfat frozen desserts

Miscellaneous

All herbs and spices such as oregano, salt, catsup, soy sauce, and vinegar.

Foods to Avoid

Breads and Cereal Breads

whole grains such as whole wheat, sprouted wheat, bran, breads with seeds or nuts such as poppy, sesame, rye, nut breads Muffins: made with nuts or seeds, fruit skins, or whole grains such as whole wheat or bran Cereals: bran cereals, whole grain, fiber, cereals with nuts Pasta/rice: wild rice, whole-wheat noodles

Fruits and Vegetables

Fresh Fruit/Frozen Fruit: All except banana Canned Fruit: Berries, grapes, berry pie" filling, jams and preserves Dried Fruits: AVOID ALL Fruit/Vegetable Juices: Prune juice, large quantities of citrus juices Fresh Vegetables/Frozen Vegetables: ALL RAW VEGETABLES, cooked onions, cabbage, brussels sprouts, broccoli, green peppers, corn, cauliflower, dried beans/peas/lentils, turnips, rutabagas, vegetables cooked in cream sauce, potato skins, french fries, eggplant Canned Vegetables: Onions, cabbage, corn, Brussels sprouts, dried beans/peas/lentils, olives, pickles

Fats

Large amounts of added mayonnaise, margarine, gravies, and dressings

Beverages

Regular coffee and tea, caffeinated sodas, alcohol (beer, wine, liquor, mixed drinks)

Meat/Other Protein

Fried meats, fatty meats, cured meats, cold cuts, poultry skin, fried eggs, high-fat cheeses (natural cheese), lima beans, peas, all dried legumes

Soups

Broth- soups made with foods to avoid, cream-based soups made with whole milk or made with foods to avoid (e.g., French onion, cream of broccoli)

Desserts

Rich desserts, pies, frosting made with fat and whole milk, coconut, candied fruits

Milk

All other milk beverages or products

Miscellaneous

Hot pepper, black or white pepper used in large quantities, popcorn, potato chips

This information was conducted in affiliation with the Walther Cancer Institute, Indianapolis, IN