Bowel changes after cancer treatment
Find out more about coping with bowel function after treatments for bowel cancer.
Managing bowel changes after treatment
Surgery to remove colon or rectal cancer or having radiotherapy to the pelvis can cause bowel changes.
These often improve in the weeks or months after treatment finishes. Or you may have some ongoing changes that you find you can manage with some of the advice on this page.
Related pages
After radiotherapy
If you had pelvic radiotherapy to the rectum it is common to have bowel side effects. They may continue to get worse for a few weeks after treatment, before gradually starting to get better. You may need to take anti-diarrhoea tablets for a while or drugs to help with tummy cramps. Your radiotherapy team may also advise you to make some changes to your diet.
Sometimes bowel side effects, such as diarrhoea or bleeding from the back passage do not completely go away. These are called late effects. Always tell your cancer team about side effects that do not improve or if you develop new side effects. We have more information about managing bowel late effects of pelvic radiotherapy.
After colon surgery
After colon surgery it may take several weeks or months before your bowel function settles into a more regular pattern. To begin with, you may notice one or more of the following changes:
- You need to pass stools (poo) more often. This might be several times a day.
- You feel that you cannot wait when you need to pass stools (urgency).
- You have diarrhoea.
- You have constipation.
- You feel bloated or pass a lot of wind.
- You have a sore bottom.
- Some food and drinks affect your bowel movements.
Any changes usually improve over time. Tell your surgeon or specialist nurse if you are having problems, or if your bowel movements are not settling into a more regular pattern. They can give you advice, prescribe medicines or refer you to a continence specialist nurse or dietitian.
Related pages
After rectal surgery
Most people have changes in how their bowel works after rectal surgery.
If you have had a transanal local excision and you do not have a stoma, your bowel will usually recover quite quickly.
After an anterior resection, you may have a temporary stoma. After the stoma has been reversed, it can take several months for your bowel function to settle into a more regular pattern. For some people, bowel function may never become regular.
If you had radiotherapy or chemoradiation before or after rectal surgery, this will also affect your bowel. This could mean it takes longer to get back to having regular bowel movements.
After rectal surgery, as well as the changes listed above you may notice the following changes:
- You are losing control over when you empty your bowels (incontinence).
- You have difficulty telling the difference between wind and stools.
Tell your surgeon or specialist nurse if you are having problems.
Related pages
Diet after bowel surgery
Your doctor, dietitian or specialist nurse will probably advise you to follow a specific diet while your bowel recovers from surgery. They may give you different advice depending on:
- the type of surgery you have had
- how much of your bowel has been removed
- whether you have a stoma.
There are things you can do to help you cope with changes to your bowel function:
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Eat at regular times to encourage your bowel to work more regularly
You may find it easier to eat several small meals a day, rather than 1 or 2 large meals.
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Include high-protein foods such as fish, meat, eggs, tofu and dairy products in your diet
This will help your body to heal after surgery.
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Follow a low-fibre diet for the first few days after surgery
To allow your bowel to recover, you may be advised to choose low-fibre foods such as white bread, pasta and plain crackers.
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Try and eat a healthy, well-balanced diet
But some healthy foods may cause problems. Depending on the type of surgery you had, you may be advised to avoid some types of high-fibre foods. These include foods with pips, skins of fruit, undercooked and raw vegetables.
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Keep a diary of what you eat and how it affects you
This can help you remember which foods are causing you problems. This means you are aware of what to avoid in your diet. As your bowel settles, try to gradually reintroduce foods that caused you problems. You may find they no longer affect your bowel. You can download our food and symptom diary [PDF].
Always check with your dietitian, doctor or specialist nurse if you are not sure what to do.
Coping with bowel changes
There are things you can do that can help you cope with bowel changes. These can help you feel more confident and in control. If your symptoms continue, always ask for help from your cancer doctor or specialist nurse.
Diarrhoea
Diarrhoea is a common side effect after surgery and during cancer treatment. It is not usually caused by the food that you eat. But making small changes to your diet might help.
You may be advised to add some fibre (roughage) to your diet. This can help to reduce diarrhoea, as it bulks up stools. Foods high in fibre include:
- wholemeal breads
- oats
- peeled or tinned fruit
- well-cooked root vegetables.
It is important to drink plenty if you have loose stools or diarrhoea or constipation. Try to drink at least 2 litres of fluid a day (3½ pints).
Fluids can include:
- water
- milk
- juice
- hot drinks, such as tea, coffee or hot chocolate
- isotonic sports drinks.
If you have a lot of diarrhoea or stoma activity, tell your dietitian or stoma care nurse. They can explain changes you could make to your diet to help manage diarrhoea.
Anti-diarrhoea tablets
Your cancer doctor or specialist nurse may recommend that you take anti-diarrhoea drugs.
The most commonly used drug is loperamide. It slows down your bowel movements, making stools more solid and less frequent. It is available on prescription, or you can buy it from a pharmacy. Some people find that taking loperamide regularly, 30 minutes before meals, works well for them.
It may take time to find the dose that works best for you. Your doctor or specialist nurse may recommend you start with a low dose and increase this until it works.
It is safe to take loperamide for as long as you need it. But you should discuss this with your doctor or specialist nurse.
Wind
You may have problems with excess wind or bloating after surgery. The following tips may help:
- Try to avoid food and drink that can cause wind – this includes beans, garlic, onions, sugar-free chewing gum, fizzy drinks and some alcoholic drinks.
- Eat slowly and chew food well.
- Take peppermint capsules or drink peppermint diluted with warm water. You can get these from your local pharmacy.
- Drink peppermint or fennel tea.
Constipation
Constipation can sometimes be a problem after surgery. If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular, gentle exercise, like going for short walks.
A dietitian can talk to you about changes you can make to your diet to help with constipation. If you have a stoma, your stoma care nurse will give you advice about your diet.
We have information about cancer and common eating problems and what can help.
Protect your skin
If you had treatment for rectal cancer or colon cancer, emptying your bowels frequently or having loose stools can make the skin around your bottom sore. These tips may help:
- Keep the skin around your bottom clean and dry. Whenever possible, wash the area after a bowel movement.
- Use unperfumed wet wipes or damp cotton wool instead of toilet paper. These are softer on your skin. Pat the area gently when drying.
- Use absorbent pads and barrier wipes or sprays to help protect your skin. A colorectal or continence nurse can advise you about pads and creams to use.
- Wear cotton underwear. This allows your skin to breathe. Avoid tight jeans or other clothes that may rub the area.
Living with bowel changes
Going out
If your bowel movements are not predictable, you may feel worried about going out, especially to somewhere new. Planning ahead so that you are prepared can help you feel more confident.
The Bladder and Bowel Community offers a Just Can’t Wait card. This may help you to get access to a toilet more quickly when you are out. It states that the card holder has a medical condition that requires urgent access to a toilet. You can either order a plastic card by post or download your card onto your smartphone.
You may find it easier to use a disabled toilet. These usually offer more privacy. They have a wash basin and more space if you need to change.
The National Key Scheme offers people with a disability access to about 10,000 locked public toilets across the UK. You can buy a key from Disability Rights UK. They can also send you details of where the toilets are.
Macmillan also has a toilet card for people who have problems with bowel or bladder control. It should help you get urgent access to a toilet when out in public. You can get a toilet card by contacting our support line for free on 0808 808 0000 You can also download it as a PDF or order one at orders.macmillan.org.uk.
Carry a bag with supplies
Pack a bag with things you may need when you go out. This will make you feel more confident and help you to cope if an accident happens.
You may want to include:
- wet wipes
- barrier cream, such as Cavilon® or Sudocrem®
- loperamide (anti-diarrhoea tablets), if you have bowel control problems
- pads and spare underwear
- stoma supplies if you have a stoma
- a change of clothing
- a sealable bag.
Managing stress
Your emotions can affect your bowel. Anxiety and stress can make your stools looser and bowel movements more frequent. If you do not feel in control of your bowel, this can also be stressful.
Learning how to relax may help your bowel settle. Relaxing is also good for your general health. Your cancer doctor or specialist nurse can tell you about any relaxation classes in your area or online. Some support groups also offer classes.
Some people find that complementary therapies such as massage or yoga help them feel less stressed.
Pelvic floor exercises
There are exercises you can do to strengthen the muscles used for bowel control. There are 2 main groups of muscles that are important for bowel control:
- the sphincter muscles in the back passage (anus)
- the pelvic floor muscles.
Pelvic floor muscles are also important for bladder control and sexual function.
Pelvic floor exercises may help if you have problems with leakage of wind or stools from your back passage. A colorectal or continence specialist can tell you if these exercises are likely to help you. They can also teach you how to do them.
It can take at least 12 weeks of doing pelvic floor exercises, 3 times a day, to rebuild strength in these muscles. As your muscles improve, try doing the exercises while doing everyday jobs.
We have more information about pelvic floor exercises after treatment.
Where to get help and support
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Colostomy UK
Colostomy UK provides practical help, support and reassurance to people who have or are about to have a stoma (colostomy), their carers, friends, and families.
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IA – Ileostomy and Internal Pouch Association
IA – Ileostomy and Internal Pouch Association offers support to help anyone who has had, or is about to have, their colon removed and has an ileostomy or internal pouch.
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Bowel Cancer UK
Bowel Cancer UK offers information and support to people affected by bowel cancer.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our bowel cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
National Institute for Health and Care Excellent (NICE). Colorectal cancer. NICE guideline [NG151]. Last update Dec 2021. Available from: www.nice.org.uk/guidance/NG151 [accessed Jan 2023].
Cervantes A, Adam R, Rosello S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. 2023 ;34(1):10-32. Available from: www.annalsofoncology.org (accessed Jan 2023).
Dr Paul Ross
Reviewer
Consultant Medical Oncologist
Guy's and St Thomas' NHS Foundation Trust
Date reviewed
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