What can I do to help my bowel function?
After you’re diagnosed with colorectal cancer, poop becomes a major topic of conversation. Tumors in the colon or rectum can cause blockages and bowel issues. Chemotherapy, targeted therapies, checkpoint inhibitors, radiation and surgeries can cause issues with bowel function too. In fact, most patients will experience at least some degree of bowel issues at some point during their treatment. Many of these symptoms will be relatively mild and temporary, although some can be more serious or require long-term management.
Luckily, you are not alone! We’re here to help you. In this section, we’ll give you some tips for managing bowel function.
We’ll cover the following issues that patients commonly experience:
Constipation
You might experience constipation due to a tumor partially blocking a section of your digestive tract, making it more difficult for waste to pass through your system. Some medications, chemotherapy, targeted therapies, and checkpoint inhibitors can cause constipation for some patients.
Here are some tips:
Consult your team
Constipation can be caused by anti-nausea and pain medications given before chemo (pre-meds). If you are experiencing constipation, the first thing you should do is consult with your care team. Your oncologist or dietician will offer you advice appropriately tailored to your personal situation. They may be able to adjust your pre-meds to help provide some relief from constipation. You can also reach out to a palliative care specialist, whose job it is to help patients manage side effects! Ask your oncologist for a referral.
Try OTC medications
You can go to the drug store and by over-the-counter (OTC) laxative medications. Make sure to run your choices past your oncologist before starting, because laxatives can be dehydrating.
Here are some options:
- Osmotics — These medications draw water from the body into the colon, softening poop and helping it pass more easily through the digestive tract. Some examples are Miralax and Milk of Magnesia
- Stool softeners — These medications also add water to poop, helping soften it. Examples include Colace and Surfak
- Bulk formers — These drugs absorb water and help bulk up poop, which encourages the intestines to contract normally and move the poop through the digestive tract. Some examples are Metamucil and Benefiber
- Stimulants — These medications help the bowels contract, which moves poop through the digestive system. Examples include Ducolax and Senokot
Depending on what is causing your constipation, certain laxatives may be more effective for you than others. Your healthcare team should be able to help advise you, and it may require a bit of trial and error to get the right combination and dosage for you.
Make dietary adjustments
Before you make any major dietary changes, chat with your oncologist or dietician.
Here are some tips:
Increase fluid intake
When you are dehydrated, your body tries to absorb as much water as possible from your poop, increasing constipation. Fluids help soften your poop, which makes it easier to pass through the digestive tract. Increasing your intake of flavored sparkling water, watered down juices, and herbal teas can be tasty and hydrating at the same time. Caffeinated drinks such as coffee and black tea can be dehydrating, but they can also help stimulate the bowels
Adjust your fiber intake
Fiber is essential for regulating bowel function, so boosting fiber intake can help with constipation. That said, it’s important to understand the different types of fiber and how they work in your body. There are two types of fiber: Soluble fiber and insoluble fiber.
Soluble fiber dissolves in water and is present in higher quantities in foods like whole grains, beans and legumes. This type of fiber adds bulk to our poop. While this can help move things along if your bowels are in good working order, it might not be the best choice for someone dealing with a tumor partially blocking a section of their digestive tract.
Insoluble fiber does not dissolve in water. It passes through the small intestine undigested, and moves into the large intestine where it feeds our gut bacteria. This type of fiber is present in higher quantities in fruits, vegetables, nuts and seeds.
The best way to get the right fiber balance is to experiment with adjusting the different types of fiber in your diet to try and find a combination that works best for you.
Limit high fat/low fiber foods
Foods that contain large amounts of fat and low amounts of fiber, such as dairy products and fried foods, can slow down digestion and make constipation worse. If you’re having problems with constipation, try limiting intake of these types of foods for a little while to see if it helps.
Get advice from a cancer dietician
Know that your diet may need to change over time, as your personal circumstances and treatments evolve. A cancer dietician can be a great resource to help you navigate the changes with personalized suggestions. Most cancer centers have a registered dietician on staff. Simply ask your oncologist for a referral! Many dieticians are able to consult remotely or will visit you while you are getting your chemo to cut down on too many extra appointments.
Exercise
If you are experiencing mild constipation, exercise can be a great way to get your bowels moving. If you’re able to, going for a brisk walk, light jog, moderate aerobic exercise, or some yoga can help stimulate the bowels. While this may not be effective for more extreme cases, it certainly can’t hurt in moderation.
Finally, if you are experiencing severe constipation or pain caused by constipation, contact your care team. You may need immediate medical attention.
Diarrhea
Diarrhea is another common symptom experienced by colorectal cancer patients. It’s often caused by chemo, targeted drugs, checkpoint inhibitors and pelvic radiation.
Here are some tips:
Consult your care team
If you are experiencing diarrhea, the first thing you should do is consult with your care team. Your oncologist or dietician will offer you advice appropriately tailored to your personal situation. You can also reach out to a palliative care specialist, whose job it is to help patients manage side effects! Ask your oncologist for a referral.
Try medications
You can go to the drug store and buy over-the-counter (OTC) antidiarrheal medications. Make sure to run your choices past your oncologist before starting anything new.
Here are some options:
- Bismuth subsalicylate — These medications help balance out the way that fluid moves through your digestive tract, which can help reduce intestinal inflammation. Examples include Kaopectate or Pepto-Bismol.
- Magnesium citrate — This medication works by increasing the fluid in the small intestine. CALM magnesium supplements contain a mild form of magnesium citrate that can help with regularity.
- Loperamide — This medication slows down the digestive tract and reduces frequency of bowel movements. Immodium is an example
- Lomotil — This drug requires a prescription. Lomotil is a combination of diphenoxylate (which slows down your gut motility) and atropine (which helps with cramping)
Make dietary adjustments
Before you make any major dietary changes, chat with your oncologist or dietician.
Here are some tips:
Increase intake of certain foods
Some foods can help slow down digestion. Foods low in fiber, such as white toast, pasta, rice, eggs and chicken can help.
Avoid certain foods
Fried foods, high-fiber foods (beans, legumes, whole grains, raw fruits and vegetables) and spicy foods can irritate the digestive tract and make diarrhea worse. Try cutting these foods out of your diet for a few days until your symptoms improve.
Eat smaller meals
Eating large meals can further irritate your digestive tract. By eating several small meals or snacks throughout the day, it may be easier for your body to process and digest the foods you eat.
Increase fluid intake
Diarrhea can cause dehydration, as the body loses more fluids than it is taking in. It’s important to keep up your fluid and electrolyte intake. Water, watered-down juice, broths, and herbal teas are good choices. Pedialyte or electrolyte powders stirred into water or juice can help replace lost electrolytes. Avoid alcohol and caffeinated drinks, as they can be dehydrating and further irritate the digestive tract.
Managing a sore bum
After a bout of diarrhea, you might be feeling pretty sore! Here are some suggestions:
- Be gentle while wiping. Try toilet paper moistened with water or a fragrance-free wet wipe. Remember that many wet wipes are not flushable.
- Try a bidet. There are portable, hand-held options or heated ones you can easily install in your toilet. This will help with irritation from wiping.
- Have a warm bath. Pat the area dry, don’t rub!
- Ask your doctor about soothing creams to apply to your anus. Applying a bit of Vaseline after wiping can help with irritation.
- Avoid wearing tight pants or underwear. Try breathable materials like cotton.
Get advice from a cancer dietician
Know that your diet may need to change over time, as your personal circumstances and treatments evolve. A cancer dietician can be a great resource to help you navigate the changes with personalized suggestions. Most cancer centers have a registered dietician on staff. Simply ask your oncologist for a referral! Many dieticians are able to consult remotely or will visit you while you are getting your chemo to cut down on too many extra appointments.
If you are experiencing severe diarrhea that does not stop on its own after a few hours, it’s important to contact your care team. You may need immediate medical attention.
Tenesmus (Feeling like you need to poop)
You might have experienced tenesmus without really knowing the word for it. It’s a frequent and urgent need to poop without much results. It leads to patients spending a lot of time on the toilet without actually passing much poop. If you have colorectal cancer, tenesmus can be caused by several different factors. It can be caused by a tumor partially blocking the digestive tract. It can also be a side effect of pelvic radiation, as these treatments can damage the nerve endings in the rectum — making you feel like you need to poop when you really don’t! Tenesmus is also a common side effect after LARS, which some patients experience following ostomy reversal surgery.
Here is some advice:
Consult your team
If you are experiencing tenesmus, the first thing you should do is consult with your care team. Your oncologist or dietician will offer you advice appropriately tailored to your personal situation. You can also reach out to a palliative care specialist, whose job it is to help patients manage side effects! Ask your oncologist for a referral.
Make dietary adjustments
Increase fluid intake
When you are dehydrated, your body tries to absorb as much water as possible from your poop, increasing constipation. Fluids help soften your poop, which makes it easier to pass through the digestive tract. Increasing your intake of flavored sparkling water, watered-down juices, and herbal teas can be tasty and hydrating at the same time. Caffeinated drinks such as coffee and black tea can be dehydrating, but they can also help stimulate the bowels
Adjust your fiber intake
Fiber is essential for regulating bowel function, so boosting fiber intake can help with constipation. That said, it’s important to understand the different types of fiber and how they work in your body. There are two types of fiber: Soluble fiber and insoluble fiber.
Soluble fiber dissolves in water and is present in higher quantities in foods like whole grains, beans and legumes. This type of fiber adds bulk to our poop. While this can help move things along if your bowels are in good working order, it might not be the best choice for someone dealing with a tumor partially blocking a section of their digestive tract.
Insoluble fiber does not dissolve in water. It passes through the small intestine undigested, and moves into the large intestine where it feeds our gut bacteria. This type of fiber is present in higher quantities in fruits, vegetables, nuts and seeds.
The best way to get the right fiber balance is to experiment with adjusting the different types of fiber in your diet to try and find a combination that works best for you.
Exercise
Exercise can be a great way to get your bowels moving. If you’re able to, going for a brisk walk, light jog, moderate aerobic exercise, or some yoga can help stimulate the bowels.
Bowel training
This process can sometimes help patients regulate bowel movements and improve tenesmus symptoms. It usually involves setting a specific schedule of when to go to the bathroom, making sure to allow yourself plenty of time to practice relaxing the bowel muscles. You might want to get a stool to rest your feet on while pooping. This moves your body into a more natural and comfortable position to poop.
Soothing baths
Sitz baths are great for relieving butt cramps. Try sitting in warm — but not hot — water for about 15 minutes after each bowel movement.
Pelvic floor physical therapy
If you’re experiencing tenesmus after an ostomy reversal surgery, pelvic floor therapy can help strengthen the muscles you use to poop. These muscles may have been weakened due to radiation, surgery, and the fact that your colon and rectum have been inactive for a while! Strengthening these muscles can help the body control its bowels. Pelvic floor physical therapists use biofeedback and apply pressure to the pelvic floor to re-establish connections between muscles and nerves. You should be able to request a referral from your surgeon or primary care provider.
Lower anterior resection syndrome (LARS)
This is probably the most common side effect patients experience after lower anterior resection surgery or ostomy reversal. LARS refers to a group of symptoms related to bowel function. If you think you may have LARS, chat with your doctor about the symptoms you are experiencing.
These symptoms include:
- Increased urgency/frequency of bowel movements
- Incontinence
- Clustering (needing to poop several times in a short time period)
- Constipation
- Uncomfortable gas
- Abdominal pain
We don’t exactly understand what causes LARS yet. Unfortunately, these symptoms are quite common, particularly in the first year or so following reversal surgery. Many patients report that they have a negative effect on their quality of life, but there are some things you can do to improve symptoms.
Here are some tips:
Consult your team
If you find your quality of life is affected by LARS symptoms, the first thing you should do is consult with your care team. Your oncologist or dietician will offer you advice appropriately tailored to your personal situation. You can also reach out to a palliative care specialist, whose job it is to help patients manage side effects! Ask your oncologist for a referral.
Make dietary adjustments
Adjust your fiber intake
Fiber is essential for regulating bowel function, so boosting fiber intake can help with constipation. That said, it’s important to understand the different types of fiber and how they work in your body. There are two types of fiber: Soluble fiber and insoluble fiber.
Soluble fiber dissolves in water and is present in higher quantities in foods like whole grains, beans and legumes. This type of fiber adds bulk to our poop. While this can help move things along if your bowels are in good working order, it might not be the best choice for someone dealing with a tumor partially blocking a section of their digestive tract.
Insoluble fiber does not dissolve in water. It passes through the small intestine undigested, and moves into the large intestine where it feeds our gut bacteria. This type of fiber is present in higher quantities in fruits, vegetables, nuts and seeds.
The best way to get the right fiber balance is to experiment with adjusting the different types of fiber in your diet to try and find a combination that works best for you.
Avoid irritating foods
If you know some foods are difficult for your body to handle, consider limiting or cutting these foods from your diet. Common trigger foods include fried foods, fatty foods, dairy, spice, alcohol and coffee. However, the foods that irritate you might not be on our list! So it’s important to listen to your body, and be open to adjusting your diet. Keeping a food journal for a couple weeks can help you track what you eat and what symptoms you experience.
Increase your fluid intake
Adequate hydration is crucial for regular bowel function. Aim to drink 8 to 10 glasses of water a day to keep things moving, but don’t beat yourself up if you don’t reach this goal.
Pelvic floor physical therapy
If you’re experiencing tenesmus after an ostomy reversal surgery, pelvic floor therapy can help strengthen the muscles you use to poop. These muscles may have been weakened due to radiation, surgery, and the fact that your colon and rectum have been inactive for a while! Strengthening these muscles can help the body control its bowels. Pelvic floor physical therapists use biofeedback and apply pressure to the pelvic floor to re-establish connections between muscles and nerves. You should be able to request a referral from your surgeon or primary care provider. For best results, ask for a referral to pelvic floor physical therapy within the first year after LAR surgery.
Try OTC medications
You can go to the drug store and buy over-the-counter (OTC) antidiarrheal or laxative medications. Make sure to run your choices past your oncologist before starting anything new.
If you’re experiencing constipation, check out the section above on constipation medications.
If you’re experiencing diarrhea, check out the section on anti-diarrheals.
Exercise
If you are experiencing mild constipation, exercise can be a great way to get your bowels moving. If you’re able to, going for a brisk walk, light jog, moderate aerobic exercise, or some yoga can help stimulate the bowels. While this may not be effective for more extreme cases, it certainly can’t hurt in moderation.
Get advice from a cancer dietician
Know that your diet may need to change over time, as your personal circumstances and treatments evolve. A cancer dietician can be a great resource to help you navigate the changes with personalized suggestions. Most cancer centers have a registered dietician on staff. Simply ask your oncologist for a referral! Many dieticians are able to consult remotely or will visit you while you are getting your chemo to cut down on too many extra appointments.
Want to learn more about managing LARS?
Check out the LARS Collective’s resource library.
Want to learn more about bowel management?
Join one of our COLONTOWN support groups:
- In the Healthy Habits Highway, we talk about ways to use diet and exercise to maximize wellbeing while going through treatment
- If you’ve had an ostomy reversal, check out Reversal Roundabout
- For more information on LARS, try LAR Junction
Want to join? Fill out the registration form here.
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Last updated: April 12, 2023