Bowel changes after cancer treatment

Most people have changes in how their bowel works after rectal surgery. If you had a local resection, your bowel will usually recover quite quickly.

After total mesorectal excision (TME), it could take several months for your bowel function to get into a more regular pattern. It may never be the same as it was before the cancer. In time, it should settle into more of a routine that will become normal for you. 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 also have:

• loss of control of when you empty your bowels (incontinence)
• difficulty telling the difference between wind or stools

Tell your surgeon or specialist nurse if you are having problems.

It may take time for your bowel function to settle. But there are things that can help you cope with bowel changes and feel more confident and in control. If your symptoms continue, always ask for help from your cancer doctor or specialist nurse.

If you have diarrhoea, 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
• beans
• oats
• fruit and vegetables.

It is important to drink at least 2 litres of fluid a day, especially if you have loose stools or diarrhoea, or constipation. Fluids can include:

• water
• milk
• juice
• hot drinks.

You may have a lot of diarrhoea or pass a lot from your stoma. If this happens, have less fluid at mealtimes.

Your cancer doctor or specialist nurse may recommend you take anti-diarrhoea drugs. The most commonly used drug is loperamide (also called Imodium® or Diareze®). It slows down your bowel movements, making the stools more solid and less frequent.

Taking loperamide regularly, half an hour before meals, works well for some people. Loperamide is also available as a syrup, so you can change the dose as needed. It may take time to find the dose that works best for you. Your cancer doctor 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 cancer doctor. Your dietitian can explain changes you could make to your diet to help manage diarrhoea.

You may have problems with excess wind or bloating after bowel surgery. Here are some tips:

• Try to avoid food and drink that can cause wind – these include beans, garlic, onions, sugar-free chewing gum, fizzy drinks and some alcoholic drinks.
• Eat slowly and chew food well.
• Taking peppermint capsules or drinking peppermint water diluted with some warm water might help. You can get these from your local pharmacy.
• Drinking peppermint or fennel tea may also help.

Constipation can sometimes be a problem after surgery to your bowel. 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.

If you have constipation, contact your GP or hospital for advice. Your doctor can give you drugs called laxatives to help.

Ask your dietitian about what changes you can make to your diet. If you have a stoma, your stoma nurse will give you advice about this.

We have information about eating problems and cancer that explains common eating difficulties and offers practical tips for managing them.

If you had treatment for rectal 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 back passage clean and dry. Whenever possible, wash the area after a bowel movement.
• Use unperfumed wet wipes, as they are softer on your skin than toilet paper. Pat the area gently when drying.
• You may find wiping with damp cotton wool softer on your skin.
• Use absorbent pads and barrier creams (such as Cavilon®, Sudocrem® or Bepanthen) to help protect your skin. A colorectal or continence nurse can tell you the best pads and cream to use.
• Wear cotton underwear, which allows your skin to breathe. Avoid tight jeans or other clothes that may rub the area.