Coping with diet & bowel changes

Sunday 1 February, 2015

Download PDF Order FREE booklet

On this page: Incontinence | Having a stoma | Coping with a stoma | Diet after treatment 


After treatment for bowel cancer, many people find that they need to adjust to changes to their digestion or bowel function.

While you don’t have to follow a strict diet after treatment, many people find that certain foods cause them discomfort and could make bowel problems worse.

Incontinence

The movement of waste through the large bowel can become faster after surgery or radiotherapy. This can mean you need to go to the toilet more urgently and more often. It may also result in a loss of control over bowel motions (faecal incontinence).

Bowel surgery or radiotherapy may weaken the anus, making it difficult to hold on when you feel the need to empty your bowels, particularly if you have loose stools (diarrhoea).

It is common to have difficulty controlling when you pass urine (urinary incontinence), and you may find that you urinate more often or do not fully empty the bladder. For example, radiotherapy to the pelvis can irritate the lining of your bladder, which is near your large bowel. This can cause temporary urinary incontinence.

If you have bladder or bowel changes, you may feel embarrassed, but there are ways to manage the symptoms. Incontinence issues usually improve with time, although it can take months or even years. Talk to your health care team about whether any bowel or bladder changes are likely to be permanent.

Managing bowel and bladder changes
  • Go to the toilet frequently to empty your bladder or bowels.
  • Carry extra underwear and some non-alcohol cleansing wipes in case you accidentally soil yourself.
  • Consider whether wearing a continence pad or disposable undergarment would give you peace of mind.
  • Ask your doctor if there are any medications for your continence problems. You might be able to take something before going out when you know it will be difficult to reach a toilet quickly (e.g. at concerts).
  • If the skin around the anus or bottom is sore, itchy or broken, ask your doctor or pharmacist to recommend a suitable cream to soothe and heal it.
  • Use non-alcohol cleansing wipes rather than dry toilet paper after a bowel motion to help reduce irritation.
  • Talk to a dietitian about changes to your diet that may help reduce incontinence. See also advice on diarrhoea and diet.
  • Visit the National Public Toilet Map to locate public toilets. You can also download the National Public Toilet Map iPhone App from the iTunes App Store.
  • Read Improving Bowel Function After Bowel Surgery, produced by the National Continence Management Strategy or call 1800 33 00 66.
  • Talk to the continence nurse at your hospital for support and information.
  • Contact the Continence Foundation of Australia on 1800 33 00 66, or visit continence.org.au. Their nurses offer confidential advice and have pamphlets on strengthening exercises that may help you ‘hold on’.

Having a stoma

A stoma is a surgically created opening in the abdomen that allows faeces to leave the body. Part of the bowel is brought out through the opening and stitched onto the skin. Some people need a stoma after bowel surgery.

The two types of stoma are a colostomy (made from the large bowel) and an ileostomy (made from the small bowel).

Colostomy

A colostomy is a stoma made from an opening in the colon (large bowel).

Types of stoma - Colostomy

Ileostomy

An ileostomy is a stoma made from an opening in the ileum (small bowel).

Types of stoma - Ileostomy

A stoma may be temporary or permanent. A temporary stoma is needed only until the newly joined bowel has healed. The surgeon will determine the safest time to close your stoma.

Less than 10% of people with bowel cancer need a permanent stoma. Like the inside of the mouth, a stoma is soft, moist, and red or pink in colour. It may be level with the surrounding skin or slightly raised. The stoma itself doesn’t have any feeling, but the skin around it does.

Stomas vary in size and can change shape during the weeks after surgery. A stomal therapy nurse can give you advice about any changes to your stoma or the skin around it.

Paul’s story

"The first sign of the bowel cancer was that I had a little bit of bleeding when I went to the toilet. I thought it might be polyps, but when it became more frequent and heavy, I decided to go to the GP.

"My GP put me onto a specialist who used a little camera to have a look inside. I went to have a colonoscopy a week later. Right away, my doctor showed me a picture of a large tumour in my lower bowel.

"The cancer was aggressive, so my medical team wanted to start treating it right away. They recommended a short course of radiotherapy followed by an operation.

"I had a week of intense radiotherapy. I experienced some nausea, so I’d have to take some medicine for that about an hour afterwards. The treatment also caused some stomach upset.

"Before the operation, I saw a stoma nurse who talked to me about what to expect.

"The surgeon planned to make a temporary stoma, but halfway through the operation, he saw that the tumour was all the way down the bowel and he had to make a permanent one.

"I’m used to the colostomy now, but I have my up and down days. I feel self-conscious sometimes because I think the bag is noticeable under most fitted men’s clothing. Other people say it’s not noticeable, but I don’t wear the same things I used to.

"I have learnt to live with the stoma. It took some time, but I worked out which foods went through easily. Having a colostomy hasn’t stopped me travelling – I’ve been able to holiday in Bali a couple of times."

Tell your cancer story.

How the stoma works

When the bowel moves, wind and waste material (faeces) come out through the stoma. You cannot control when this happens, but a small disposable bag is worn on the outside of the body to collect the waste. This is called a stoma bag or an appliance.

Stoma bags have adhesive on the back, so they should stick firmly to the skin and provide a leak-proof, odour-proof system. A filter lets out any wind (but not the odour), which should stop the wind inflating the bag. The bags usually can’t be seen under clothing.

Attaching the bag – Your stomal therapy nurse will help you choose an appliance that suits your body shape and the stoma, and will explain how to attach it securely.

Emptying the bag Stoma bags can be drainable (able to be emptied) or closed (discarded after each bowel movement). With an ileostomy, you wear a drainable bag because the waste material tends to be watery or soft. With a colostomy, the bag may be drainable or closed, depending on the consistency of your waste material. A drainable bag has to be emptied down the toilet when it is about one-third full. A closed bag should be put in a rubbish bin after each bowel movement (not flushed down the toilet).

Some people don’t like to wear stoma bags. If you have a colostomy in your descending colon, you may be able to learn how to give yourself a type of enema (colostomy irrigation) to remove the waste every day or two. Talk to your doctor and stomal therapy nurse about this option.

Coping with a stoma

Having a stoma, even temporarily, is a big change in a person’s life and takes some adjustment. However, thousands of Australians have a stoma and most lead a relatively normal life.

The stoma may sometimes affect your travel plans, social life and sexual relationships, but these issues can be managed, especially with some planning. Unless your job or hobbies are particularly strenuous, you should still be able to participate in your usual activities.

You may worry about how you will look and how other people will react to your appearance. Although the stoma bag may seem obvious to you, most people won’t notice anything is different unless you tell them. The stoma’s location may make some clothes less comfortable (e.g. tight waistbands or belts), but you will generally be able to continue wearing your normal clothes. You might also consider buying underwear designed for people with a stoma.

To help the stoma settle and to avoid blockages, you may need to make some dietary changes. Over time, most people find they can eat a normal healthy diet. You can discuss changes to aspects of your everyday life with a stomal therapy nurse. Your family may also need information and support, and can be included in discussions with the nurse if you wish. You could also talk to the hospital or your GP about seeing a counsellor if you feel like you need some emotional support.

Stoma Appliance Scheme

The Australian Government has a Stoma Appliance Scheme (SAS), which provides free stoma supplies to people with a temporary or permanent stoma. More than 40,000 people use the scheme.

To be eligible for the SAS, you must hold a Medicare card and belong to a stoma association. Your stomal therapy nurse will help you join an association, or you can contact them directly (see below).

The stoma supplies provided under the scheme include bags and appliances. Only certain products are covered and there is a limit to how many you can receive each month. If you need more than the maximum allowed, you can ask your GP or stomal therapy nurse to sign a certificate.

Visit health.gov.au and type ‘Stoma Appliance Scheme’ into the search box for more information.

Stoma associations

With your consent, your stomal therapy nurse will sign you up to a stoma (or ostomy) association. There is a small annual membership fee, but you will then be able to obtain free stoma appliances and products. Stoma associations also provide assistance and information to members and coordinate support groups for people of all ages.

If you would like to find out more about the stoma associations in your state or territory, visit the website of the Australian Council of Stoma Associations, or contact Cancer Council 13 11 20.

Stomal therapy nurses

If there is a chance you could need a stoma, the surgeon will probably refer you to a stomal therapy nurse before surgery.

Stomal therapy nurses are registered nurses with special training in stoma care. They can:

  • talk to you about the best place for the stoma to be located
  • answer questions about your surgery and recovery
  • provide you with printed and audiovisual resources
  • give you information about adjusting to life with a stoma, including how to look after your stoma when you are out of hospital.

For more information, contact the Australian Association of Stomal Therapy Nurses, talk to a stoma association, or call Cancer Council 13 11 20.

Diet after treatment

Immediately after treatment – particularly surgery – you might be given a special (low-fibre or soft) diet. During and after recovery from treatment, you may find that some foods cause discomfort or diarrhoea.

Your treatment team may tell you about some foods to avoid, but different foods can affect people differently, so you will probably need to experiment to work out which foods cause problems for you. It is best to limit – not eliminate – these foods from your diet, as you may find that what you can handle improves over time. Keeping a food and symptom diary can help you to work out which foods tend to cause you trouble.

If you have a stoma, you may need to make some dietary changes in the first few weeks to help the stoma settle. Nuts, seeds and very fibrous foods can lead to a blockage in the stoma. By trial and error, you might identify particular foods that irritate the stoma, but these vary considerably between people. Most people with a stoma end up eating a normal diet. If you have concerns, your doctor or stomal therapy nurse may refer you to a dietitian.

The Australian Government's booklet Improving Bowel Function After Bowel Surgery provides some helpful tips. Call 1800 33 00 66 to request a copy.

Diarrhoea

Having loose or frequent bowel motions (diarrhoea) for long periods can be distressing. The fast movement of food through your bowel before your body can absorb the water and nutrients can make you dehydrated. If left untreated, this can be dangerous. Having diarrhoea that is hard to control can also make you feel tired.

Diarrhoea may be caused by different types of treatment:

  • Surgery: If you have had part of your bowel removed, your bowel motions may be looser than you were used to. This is because the bowel absorbs water to form your stools. With a shorter bowel, the stools do not form as solidly as before. This may need ongoing management.
  • Radiotherapy: Radiotherapy often causes diarrhoea. It can take some weeks to settle down after treatment has finished. For a small number of people, diarrhoea is an ongoing issue.
  • Chemotherapy: This treatment can cause diarrhoea and nausea. These side effects will go away after treatment and you can gradually resume a normal diet.

Diarrhoea can be exhausting, so rest as much as possible and ask family or friends to help out with chores. Eat at regular intervals throughout the day and try to maintain a balanced diet so your body is nourished.

Drink plenty of water so that you don’t become dehydrated, and treat dehydration with a rehydration drink, such as Gastrolyte®. If your anus becomes sore, a pharmacist can recommend a cream.

Some people find it embarrassing to talk about diarrhoea. You may worry that diarrhoea means the cancer is still there or has come back. This is unlikely to be the case after treatment for bowel cancer.

It is important to talk to your doctor and nurses about diarrhoea. They will discuss ways to help control it, such as using medication, changing your diet and replacing fluids. You may also be referred to a dietitian or to a physiotherapist who specialises in bowel function.

Foods that may cause diarrhoea
fruit (fresh or dried) grapes, stone fruit (such as apricots, peaches and plums), most berries
vegetables and legumes capsicum, cabbage, onions, beans, peas, corn, broccoli, lentils, dried beans, baked beans, peas, brussels sprouts
alcohol beer, wine, spirits (can cause dehydration)
bran, nuts, seeds and fibre multigrain, wholemeal and high-fibre breads, some breakfast cereals
fatty foods butter, cream, fatty meats, fried foods
lactose dairy foods (such as milk, cream, yoghurt and soft cheeses)
spicy foods garlic, onion, chilli, curry
caffeine coffee, tea, chocolate, cola-type soft drinks, energy drinks
sugar-free foods and drinks the sweetener sorbitol has a laxative effect
Tips for reducing diarrhoea
  • Eat low-fibre foods, such as white rice, white pasta, white bread, rice-based cereal, potatoes, fish and lean meat.
  • Well-cooked vegetables without seeds, husks or skin, such as carrots, potato and pumpkin, are good choices.
  • Eat three small meals a day and snack often.
  • If you suspect that a food causes diarrhoea, avoid it for 2–3 weeks. Reintroduce one food at a time. If the diarrhoea flares up again, you may want to avoid that food.
Wind (flatulence)

Many people who have treatment for bowel cancer, especially surgery, find that it makes them gassy. Reducing the foods that produce wind may be helpful. In particular, try restricting foods that are high in FODMAPs (Fermentable, Oligo-, Di-, Monosaccharides And Polyols) – see table below.

Foods that may produce wind
eggs prepared any way
vegetables (raw or cooked)
broccoli, cabbage, onions, cauliflower, corn, asparagus, brussels sprouts
legumes lentils, beans
dairy products
strong cheeses, large serves of dairy products (such as milk and cream)
fizzy (carbonated) drinks
some soft drinks, beer
raw and dried fruit pears, dates, raisins, figs, prunes, grapes, pineapple, apples, bananas
Tips for reducing wind
  • Try charcoal tablets, natural yoghurt and/or peppermint tea to reduce wind.
  • Cut your food into small, bite-sized pieces.
  • Chew food slowly and thoroughly.
  • When you have a drink, take small sips.
  • Talk to your doctor about doing light exercise to relieve bloating and gas.
  • Ask a dietitian to help you with a low FODMAP diet.
Blockages

For people with a stoma, some foods can cause blockages. This means solids, fluids and gas can’t move through as they normally would. This can be uncomfortable and cause a bloated feeling or nausea. If you experience symptoms of a blockage for more than two hours or you start vomiting, contact your nurse or hospital.

Foods that may cause blockages
high-fibre foods oranges, strawberries, apples
raw vegetables cabbage, celery, carrot, tomatoes
cooked vegetables spinach, green beans, broccoli, cauliflower
seeds or kernels popcorn, nuts, coconut, corn
spicy foods chilli, curry
fruit and vegetable skins apples, grapes, tomatoes
meat casing sausages
Tips for avoiding blockages
  • Eat regular meals.
  • Try to maintain a balanced diet so your body is well nourished.
  • Drink up to eight glasses of fluid a day to stay well hydrated.
  • Chew food slowly and thoroughly.
  • Cut your food into small, bite-sized pieces.
  • If you have trouble eating a certain food, talk to a dietitian about your diet.

Key points

  • After treatment for bowel cancer, most people find their bowel functions change.
  • You may need to go to the toilet more urgently or lose control over bowel motions (faecal incontinence).
  • There are many ways to manage incontinence. For support and information, contact the Continence Foundation of Australia at continence.org.au.
  • Some people will need to have a stoma, which is a surgically created opening in the abdomen. Waste (faeces) passes out of the body through this opening. The two types of stoma are a colostomy, which takes part of the large bowel out to the abdomen, and an ileostomy, which creates a stoma from the small bowel.
  • A stoma may be temporary or permanent.
  • A stomal therapy nurse will answer any questions you have and help you adjust to life with a stoma.
  • If you become a member of an ostomy association, you will be entitled to free stoma supplies through the Australian Government’s Stoma Appliance Scheme.
  • Diarrhoea and wind are common problems after treatment for bowel cancer. You may need to change your diet, especially if the diarrhoea or wind is ongoing, or if you have a blockage.
  • It is important to drink plenty of fluid throughout the day to avoid dehydration and to reduce constipation and blockages.
  • A dietitian can give you advice on removing certain foods from your diet and tell you if and when to reintroduce them.

Reviewed by: Mr Chip Farmer, Colorectal Surgeon, The Alfred Hospital, Cabrini Hospital and The Avenue Hospital, VIC; Mervyn Bartlett, Consumer; Dr Andrew Haydon, Medical Oncologist, The Alfred Hospital and Cabrini Hospital, VIC; Jackie Johnston, Palliative Care and Stomal Therapy Clinical Nurse Consultant, St Vincent’s Private Hospital (Darlinghurst), NSW; Dr Shahrir Kabir, Fellow in Colorectal Surgery, Royal Brisbane and Women’s Hospital, QLD; Steve Pratt, Nutrition and Physical Activity Manager, Cancer Council WA; Cassie Riley, Cancer Nurse Coordinator – Colorectal, WA Cancer and Palliative Care Network, WA; Mary Shanahan, Cancer Genetics Nurse Coordinator, Peter MacCallum Cancer Centre, VIC; A/Prof Andrew Stevenson, Head of Colorectal Surgery, Royal Brisbane and Women’s Hospital, University of Queensland; Pat Walls, Clinical Nurse Consultant Stomal Therapy/Wound Management, Holy Spirit Northside Private Hospital, QLD.
Updated: 01 Feb, 2015