Change in bowel habit after treatment

Regaining bowel control can be one of the biggest challenges that you face after treatment for bowel cancer. Your bowel habits are likely to have changed after your cancer treatment and you may have:

• More frequent bowel motions
• Looser poo
• Wind
• Tummy pain
• Constipation
• A feeling that you haven’t completely emptied your bowel.  

These problems may be worse in the year after treatment but can carry on long term.

If you have had surgery for rectal cancer that avoids a permanent stoma, you may have several bowel symptoms. This is due to a condition called low anterior resection syndrome (LARS). These symptoms often get better over six to 12 months but you may find them bothersome and they can affect your daily life. Having radiotherapy increases your risk of getting this syndrome. Speak to your healthcare team if your symptoms are not getting better.

If you have a temporary stoma, you will usually have it reversed after you finish treatment. Some people find it can take several months for their bowel habit to return to normal.

Diarrhoea

Diarrhoea is loose, runny poo that you pass more often than normal. You may need to rush to the toilet several times a day.

Bowel cancer treatments, such as surgery, radiotherapy and chemotherapy, can cause diarrhoea. Other possible causes include medicines, like antibiotics, and infections.

When you have diarrhoea, you need to drink enough liquid to avoid getting dehydrated. Take regular small sips and aim for at least six to eight glasses of liquid a day.

As well as losing water, you will be losing salts and other important nutrients. To replace these, try eating fresh or tinned soups and broths. You could also have Marmite on toast or plain crackers.

Light and easily digested foods can help with diarrhoea after bowel cancer treatment. Try to eat small meals regularly throughout the day and eat slowly to avoid bloating and wind. Reintroduce fibre very slowly when your symptoms have improved.

Food and drink to try:

• Water or herbal tea
• Just-ripe bananas
• White bread, rice, pasta or noodles
• Plain crackers
• Peeled, cooked vegetables and fruit
• Low fibre cereals like puffed rice or cornflakes
• Skinned chicken or white fish
• Cooked egg whites

Food and drink to temporarily avoid:

• Drinks containing caffeine or alcohol
• Sugary and fizzy drinks
• Milk and other dairy products
• Fatty or spicy foods
• Raw fruit and vegetables
• Beans and pulses
• High fibre cereals like bran
• Brown rice, multigrain bread and cereals
• An artificial sweetener called sorbitol, found in sugar-free sweets and drinks
• Nuts and seeds

If you feel too sick to eat, or if you become very dehydrated, your GP may suggest you use oral rehydration salts. These contain a balance of salts and sugars to help your body re-absorb them quickly. You can buy them from chemists and supermarkets. Always speak to your doctor before taking any medicines for diarrhoea. They will need to find out what is causing your symptoms before deciding on the best treatment for you.

Probiotics may help to reduce the length and frequency of diarrhoea caused by infection. You may not be able to take probiotics during chemotherapy or if you have low levels of white blood cells (neutropenia) because they can increase the risk of infection. Always speak to your healthcare team before taking probiotics.

Constipation

Constipation is when your poo is hard, dry and difficult to pass. You may find it painful when you go to the toilet or you may feel like your bowel isn’t completely empty. There is no rule for how often you should be having a poo – some people go more than once a day and others go every three to four days. Both of these are normal but if you’re going to the toilet less often than you normally do, you may have constipation.

Get medical advice straight away if you haven’t had a poo for more than a few days and you have pain, feel sick or have been sick (vomited).

Always speak to your GP or healthcare team before making big changes to your diet. If you’ve had constipation for a long time, you may need medical treatment before you change your diet.

• Eating regular meals can help to relieve constipation, so eat at least three meals a day including breakfast, and try not to skip meals
• Unless you can’t tolerate fibre, increase the amount of fibre in your diet, both soluble (porridge oats, ground flaxseed, pulses, fruit, root vegetables like parsnips, turnips and carrots) and insoluble (wholegrain cereal, multigrain bread, brown rice/pasta, dark green leaves like spinach). Do this gradually and in small portions to avoid wind and bloating. Chew your food well. It can take up to four weeks for you to see any change in your bowel habit.
• Drink plenty of liquid, including water, regularly during the day, especially if you’re increasing fibre in your diet.
• Some fruits can help with constipation, like prunes, raisins, apples, pears and apricots (fresh, tinned or dried). These are high in sorbitol, a natural laxative.

Other things that can help:

• Avoiding sitting down for long periods of time.
• Regular gentle physical activity for at least 30 minutes, five days a week.
• Making sure you have enough time and somewhere private to go to the toilet, if possible.
• Sitting in a squatting position on the toilet, with your knees bent and your feet on a stool. This can help you use the right muscles to empty your bowel.
• Going to the toilet first thing in the morning or half an hour after eating.
• Not putting off going to the toilet.
• Firmly massaging your tummy in a clockwise movement can help get your bowel moving and can ease bloating and wind.

More support and information

Tell your healthcare team about any bowel problems you’re having or if your symptoms aren’t getting better. Your specialist nurse can give you information on ways to improve bowel frequency and control. They can also help you find out which foods might cause you problems.  

Your GP or specialist nurse may refer you to a specialist if:

• You wake at night to empty your bowels
• You need to rush to the toilet to empty your bowels
• You ever have any leaks, soil yourself or lose control of your bowels
• Your bowel symptoms stop you living a full life.

If you have any of these problems, you may be referred to a continence specialist, a team who specialise in retraining the bowel and the muscles involved in emptying the bowel (biofeedback team) or a doctor who specialises in problems with the digestive system (gastroenterologist).

Find out more about managing bowel function in our booklet Regaining bowel control.

Our information booklet, Eating well,  has information on diet, including coping with bowel problems, eating and drinking with a stoma and losing and gaining weight. It also includes a food and symptom diary to help you find out what foods you react to.

Visit our online community to talk about your experiences, share knowledge and get support from other people.

Updated August 2018