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About Lymphoma

Bowel issues – diarrhea & constipation

Bowel changes such as diarrhea or constipation are common for people with lymphoma.  These changes affect your poo. Other names for poo include stool, a deuce, a dump, shit, crap, turd or a ‘number two’. On this page we will use the word poo or stool. The changes to your stool can happen for several reasons including:

  • symptom of the specific subtype of lymphoma you have
  • side-effect of lymphoma treatments
  • infection or antibiotics
  • medicine you take for pain or nausea
  • anxiety or depression
  • changes to your diet and exercise.

This page will provide practical advice for managing diarrhea and constipation, and when you should talk to your doctor or nurse about changes.

On this page:

Have you opened your bowels?

Your nurses will often ask you if you have “opened your bowels”. They are asking if you have pooed. They will also want to know how often you have opened your bowels, and what the texture of it was – For example a healthy stool should be about the consistency of soft serve ice-cream and a light to medium brown colour. If your stool is:

  • runny or watery, it is considered diarrhea 
  • small and hard, or difficult to pass it may be constipation. 

The colour is also important. Stool that is too light, white or yellow may indicate you have issues with your liver. Red or black stool may suggest there is blood in your poo. However, some changes in your diet can also affect the colour of your stool.

Have you passed wind?

Opening your bowels can also mean passing wind (or farted, fluffed, passed gas). Passing wind, particularly if you have not been pooing well is important. It means that poo or wind can still pass through your bowel. If you cannot poo or pass wind, your nurses and doctors may want to check if your bowels are obstructed – or blocked. You may need to have CT scan if they need to check for an obstruction. 

Your bowels can also stop working if they become paralysed – which means they are unable to contract and relax to move the poo along.

An obstruction can happen if you have lymphoma growing in your bowels, or for other reasons. A paralysed bowel can happen due to surgery or nerve damage. So all these questions your nurses ask you, are a very important way they can make sure you get the right care.

Why are diarrhea and constipation a problem?

Apart from making you uncomfortable, diarrhea and constipation can cause more problems for you, if they’re not managed properly.

Diarrhea can:
  • Cause breaks in the skin on your bottom that can be painful, bleed or become infected.
  • Stop your body from absorbing much needed nutrients.
  • Make it difficult to get to the toilet in time (you could become incontinent).
  • Stop you from going out and socialising.
  • Cause you to become dehydrated.

Diarrhea can be graded according to how bad it gets (the severity).

Grade 1 – Means that you are having loose stool and opening bowels 1-3 times MORE than you usually would during a day.

Grade 2 -Is when you are having loose stools and opening your bowels 4-6 times MORE than you normally would during a day. This would normally impact your activities during the day.

Grade 3 – If you are having loose stools 7 or more times than you normally would in a day, you would have grade 3 diarrhea. You may need to go to hospital to help have this managed. Call your doctor. You may need intravenous fluids (fluids straight into your blood stream) to prevent dehydration. You may also need other medical support depending on the cause of diarrhea.

Grade 4 – Means that your diarrhea has become life threatening and needs urgent intervention. If you are not already in hospital call an ambulance by dialling 000.

 Constipation can:
  • Cause pain, including pain in your tummy and chest.
  • Cause indigestion (heartburn).
  • Lead to nausea and vomiting.
  • Make it difficult to pass poo (stool) resulting in you straining – which can increase risk of haemorrhoids (piles). Haemorrhoids are swollen blood vessels in your bottom (rectum and anus) that can be very painful and bleed.
  • Make it difficult to concentrate.
  • Cause blockages in your bowels that may need surgery to clear.
  • In severe cases, constipation can cause your bowel to rupture (tear open) which can become life threatening.

How is diarrhea and constipation managed?

Tip

If you are struggling to drink enough water each day, try to increase your fluids by adding some of the below into your diet. However, also check the tables below on what to avoid if you have diarrhea or constipation to help choose the best options for you.

Fruits and vegetable
Drinks
Other foods

Cucumber

Watermelon

Celery

Strawberries

Cantaloupe or rockmelon

Peaches

Oranges

Lettuce

Zucchini

Tomato

Capsicum

Cabbage

Cauliflower

Apples

Watercress

 

Water  (can be flavoured with ginger, cordial, juice, lemon, lime cucumber if you prefer)

Fruit juice

Decaffeinated tea or coffee

Sports drinks

Lucozade

Coconut water

Ginger ale

 

 

Ice cream

Jelly

Watery Soup and broth

Plain yoghurt

The first thing you need to know is the expected side-effects of your treatment. Some will cause diarrhea while others will cause constipation.

Ask your doctor or nurse if your treatment is likely to cause diarrhea or constipation. Once you know this, you can try to prevent it before it starts. Prevention is better than cure!

Foods to eat to prevent or manage diarrhea

You can help prevent or lessen diarrhea by eating certain foods. See the table below for what you should eat more of and less of to manage diarrhea.

Food to eat to prevent or manage diarrhea

Foods to avoid or have less of if you have diarrhea

 ·         Bananas

·         Apples or apple sauce or apple juice

·         White rice

·         Toast made with white bread

·         Porridge

·         Baked or boiled potatoes.

·         Milk and dairy products

·         Fried, fatty or greasy foods,

·         Pork, veal and sardines

·         Onions, corn, citrus fruits, grapes and seeded berries

·         Alcohol, coffee and sodas or energy drinks with caffeine

·         Artificial sweeteners.

Foods to eat to prevent or manage constipation

You can help prevent or lessen constipation by eating certain foods. Drink at least 6-8 glasses of water or fruit juice every day. Water helps to keep the stool soft so it is easier to pass.

See the table below for what you should eat more of and less of to manage constipation.

Food to eat to prevent or manage Constipation

Foods to avoid or have less of if you have constipation

 ·         Prunes, figs, pears, kiwi fruit, citrus fruits, rhubarb.

·         Apples (yep they’re good for both diarrhea & constipation).

·         Porridge (can help with both diarrhea and constipation – just don’t eat too much!).

·         Spinach and other green vegetables.

·         Artichoke and chicory.

·         Sweet potato.

·         Chia seeds, flaxseeds and other nuts and seeds.

·         Whole grain bread or rye bread.

·         Kefir (a fermented milk drink).

·         Anything with white flour, such as white bread, rolls or buns

·         Processed meats

·         Fried foods

·         Dairy products

·         Red meat.

Gentle exercise and massage to manage constipation

Gentle exercise and movement can help with constipation. Massage can also help. Watch the short video below to learn some exercises and massage techniques you can do at home.

Medicine to manage diarrhea and constipation

Diet, exercise and massage isn’t always enough to stop diarrhea or constipation.

Talk to your doctor, nurse or pharmacist before you take any medicine to manage diarrhea or constipation. Depending on the type of treatment you are having, you may need different management of diarrhea and constipation.

When to contact your doctor or nurse

You can contact our Lymphoma Care Nurses Monday-Friday 9am-4:30pm Eastern States Time. They can give you advice about how to manage diarrhea and constipation. They can also let you know when you should contact your doctor for more help.

As a guide, you will need to contact your doctor or nurse at your hospital if any of the below happen. You have:

  • a temperature of 38 degrees or more.
  • grade 3 diarrhea, or are having cramps, pain or other discomfort in your tummy.
  • blood in your stool. This may look like fresh red blood, or your stool may look black, or much darker than normal.
  • bleeding from your bottom.
  • smelly stool that is much more smelly than usual – this could be an infection.
  • not opened your bowels for 3 or more days.
  • a bloated tummy.

Summary

  • There are many causes for diarrhea and constipation when you have lymphoma.
  • Both diarrhea and constipation can range from a slight inconvenience, to life threatening.
  • Prevention is better than cure – Know the expected side-effects of your treatment.
  • Keep your fluids up, whether you have diarrhea or constipation you need at least 6-8 full glasses of water a day.
  • Eat the right foods for your condition. But keep it balanced. Ask your doctor to refer you to see a dietician if you would like more information on diet and lymphoma, or diet and managing diarrhea or constipation.
  • The management of your diarrhea and constipation will be different depending on the cause and the treatments you are having.
  • Contact your doctor in you get any of the problems listed under When to contact your doctor or nurse.

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Please note: Lymphoma Australia staff are only able to reply to emails sent in English language.

For people living in Australia, we can offer a phone translation service. Have your nurse or English speaking relative call us to arrange this.