Coping with diet & bowel changes
On this page: Incontinence | Having a stoma | Diet after treatment | Reviewers
After treatment for bowel cancer, many people find that they need to adjust to changes to their digestion or the way their bowel functions. 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). An operation or radiotherapy may weaken the anus, making it difficult to hold on when you feel the need to empty your bowels.
It's common to have difficulty controlling when you pass urine (urinary incontinence), urinating more often or not emptying the bladder fully. 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 experience bladder or bowel changes, you may feel embarrassed. However, both faecal and urinary incontinence usually improve with time and there are ways to manage your symptoms. Talk to your health care team about whether the changes to your bowel or bladder habits are likely to be permanent.
Tips:
Go to the toilet frequently, to empty your bladder or bowels.
- Carry an extra pair of underwear and some nonalcohol cleansing wipes in case you soil yourself.
- Consider wearing a continence pad or disposable undergarment.
- Ask your doctor for any medications to treat continence problems.
- If the skin around the anus or bottom is sore, itchy or broken, ask your doctor or pharmacist for advice on using a suitable cream to soothe and heal it.
- Talk to a dietitian about changes to your diet that may help reduce incontinence.
- Visit www.toiletmap.gov.au to locate public toilets.
- Contact the Continence Foundation of Australia for support and additional information, such as advice on strengthening exercises. Call 1800 33 00 66.
Having a stoma
A stoma is a surgically created opening in the abdomen through which part of the bowel is attached. Some people need a stoma after bowel surgery, which may be temporary or permanent, so that waste can be removed from the body.
A temporary stoma is only needed 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.
The two types of stoma are:
- colostomy: the most common type of stoma, created from an opening in the large bowel
- ileostomy: a stoma created from an opening in the small bowel.
A stoma is soft, moist and red or pink in colour as it's formed from the same type of tissue as the inside of the mouth. It may be level with your 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 in the first six months following surgery. A stomal therapy nurse can give you advice about any changes to your stoma or the skin surrounding it.
How the stoma works
When the bowel moves, wind and waste material (faeces) come out through the stoma. A small, disposable, flat plastic bag is worn on the outside of the body to collect this 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. They're usually not visible under clothing.
Attaching the bag: Your stomal therapy nurse will help you choose an appliance suitable to your lifestyle. For example, in humid weather or during vigorous physical activity, you may need to use extra stoma paste or powder to secure the bag.
Emptying the bag: When the bag is about one-third full, you'll empty the contents down the toilet. Some bags are drainable, while others need to be changed each time there is a bowel movement. Discard stoma bags in the rubbish bin instead of the toilet.
Some people don't like to wear 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 once a day. Talk to your doctor and stomal therapy nurse about this option.
Colostomy
The most common type of stoma is a colostomy, which is a stoma from an opening in the colon.
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 impact on your travel plans, social life and sexual relationships, but these issues can be managed, especially with some forward planning. Unless your job or hobbies involve very strenuous labour, the stoma should not stop you from participating in your usual activities.
You may worry about how you'll look and how other people will react to your appearance. Although the stoma bag may seem very 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'll generally be able to continue wearing your normal clothes.
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 stomal therapy nurse if you wish.
"My colostomy bag came adrift a few times. I quickly learned to carry a stoma bag replacement kit with me, in case of emergency."
—Steve
Stoma Appliance Scheme
The Australian Government has a Stoma Appliance Scheme, which provides free stoma supplies, such as bags and accessories, to Medicare cardholders with a temporary or permanent stoma who belong to a stoma association.
Visit the Department of Health and Ageing website and type ‘Stoma Appliance Scheme' into the search box for more information.
Support for people with a stoma
You'll be signed up to a stoma association so you can obtain free appliances and related products, and also get ongoing support. There may be a small joining fee. Stoma associations offer a variety of different services to members, including:
- information on all aspects of stoma care
- stoma-related products
- support groups for people of all ages
- a way to connect you to other people who have a stoma, which may help you adapt to the changes.
To find a stoma association in your state or territory, see the Australian Council of Stoma Associations website, or contact Cancer Council Helpline on 13 11 20.
Stomal therapy nurses
If there's a chance you could need a stoma, the surgeon will probably refer you to a stomal therapy nurse before surgery. You can ask to see a stomal therapy nurse if you aren't referred. Stomal therapy nurses are specially trained 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 you'll need to look after your stoma when you're out of hospital.
For more information, contact the Australian Association of Stomal Therapy Nurses, talk to an ostomy association or call the Helpline.
Diet after treatment
After treatment – particularly surgery – you won't have to follow a particular diet. However, you may find that some foods cause discomfort or diarrhoea.
Your medical team may tell you about some foods to avoid, but foods can sometimes affect people differently, so you may be told 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 your tolerance improves over time.
The Australian Government's booklet, Improving Bowel Function After Bowel Surgery, provides some helpful tips. Visit the website www.bladderbowel.gov.au to download 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's hard to control can also make you feel tired.
Diarrhoea may be caused by different types of treatment:
- Surgery: If you've had part of your colon taken out, your bowel motions may be looser than you were used to. This is because the colon absorbs water to form your stools. With a shorter colon, the stools don't form as solidly as before. This may be an ongoing problem.
- Radiotherapy: Radiotherapy often causes diarrhoea. It can take several weeks to settle down after treatment has finished.
- Chemotherapy: This treatment can cause diarrhoea and nausea. These side effects will go away after treatment and you can gradually resume a normal diet.
Some people find it embarrassing to talk about having diarrhoea. You may worry that the diarrhoea means the cancer is still there or has come back. This isn't usually the case after treatment for bowel cancer.
It's 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 physiotherapist who specialises in bowel function.
Foods that make bowel motions too soft and more frequent
| fruit (fresh or dried) | grapes, stone fruit, such as apricots, peaches and plums, and most berries |
|---|---|
| vegetables and legumes | capsicum, cabbage, onions, beans, peas, corn, broccoli, lentils, dried beans, baked beans, peas and Brussels sprouts |
| alcohol | beer, wine and spirits (can also cause dehydration) |
| bran, nuts, seeds and fibre | multigrain, wholemeal and high-fibre breads and some breakfast cereals, such as muesli |
| spicy foods | chilli and curry |
| caffeine | coffee, tea, chocolate and cola-type soft drinks and energy drinks |
| sugar-free foods and drinks | the sweetener sorbitol has a laxative effect |
Tips:
- Avoid high-fibre foods.
- Reduce caffeinated drinks, such as tea, coffee, cola and chocolate milk.
- Avoid full-fat dairy foods, such as milk, butter, yoghurt and cream, and fried foods.
- Eat foods with less fibre, such as white rice, pasta, white bread, oats, rice-based cereal, potatoes, bananas, fish, eggs and lean meat.
- Well-cooked vegetables without seeds, husks or skin, such as carrots, potato and pumpkin, are good choices.
- Try to eat three small meals, rather than three large meals, and snack frequently. Eat and drink at regular intervals throughout the day.
- Drink plenty of water so you don't become dehydrated.
- Treat or prevent dehydration with a rehydration drink, such as Gastrolyte®.
- Try to maintain a balanced diet so your body is nourished. If you have trouble eating a certain type of food, talk to a dietitian who can help you find the best diet.
- If your anus is sore, use a cream or ointment to soothe it.
- If you suspect that a certain food causes diarrhoea, avoid it for 2-3 weeks. Reintroduce one type of food at a time. If the diarrhoea flares up again, you may want to avoid that food.
- Having diarrhoea can be exhausting, so rest as much as possible and ask family or friends to help out with any chores you need to do.
Wind (flatulence)
Many people who have treatment for bowel cancer find that it makes them gassy. This can particularly be a problem after bowel surgery. Reducing the foods that produce wind may be helpful.
Foods that produce wind/gas
| eggs | prepared any way |
|---|---|
| vegetables | broccoli, cabbage, onions, cauliflower, corn, asparagus and Brussels sprouts |
| legumes | lentils and beans |
| dairy products | strong cheeses and large serves of dairy products, such as milk and cream |
| fizzy (carbonated) drinks | some soft drinks and beer |
| raw and dried fruit | pears, dates, raisins, figs, prunes, grapes, pineapple, apples and bananas |
Tips:
- Cut food into small, bite-sized pieces.
- Chew food slowly and thoroughly.
- When you have a drink, take small sips.
- Try charcoal tablets, natural yoghurt and/or peppermint tea to reduce wind and odour.
- Ask your doctor about doing light exercise, which can relieve bloating and gas.
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.
Foods that can cause blockages
| high-fibre foods | oranges, strawberries and apples |
|---|---|
| raw vegetables | coleslaw, celery, carrot and tomatoes |
| cooked vegetables | spinach, green beans, broccoli and cauliflower |
| seeds or kernels | popcorn, nuts, coconut and corn |
| spicy foods | chilli and curry |
| fruit and vegetable skins | apples, grapes and tomatoes |
| meat casing | sausages |
Tips:
- Eat regular meals.
- Try to maintain a balanced diet so your body is nourished.
- Chew food slowly and thoroughly.
- Cut food into small pieces.
- Drink up to eight glasses of fluid a day to stay hydrated.
- If you have trouble eating a certain food, talk to a dietitian about your diet.
Reviewed by: Karen Barclay, Colorectal Surgeon, The Northern Hospital, Lecturer in Surgery, University of Melbourne, VIC; Carole Arbuckle, Cancer Nurse, Cancer Council VIC; Karen Bowers, Eat it to Beat it Strategy Project Officer, Cancer Council NSW; Darrell Bowyer, Consumer; Rebecca Foot-Connolly, Stomal Therapy Nurse, The Alfred Hospital, VIC; Bernadette Hadfield, Stomal Therapy Nurse, The Alfred Hospital, VIC; Melissa Heagney, Media and Communications Advisor, Cancer Prevention Unit, Cancer Council VIC; Dorothy King, Consumer; and Loreto Pinnuck, Stomal Therapist, Wound Consultant, Paediatric Continence Specialist, Monash Medical Centre, VIC.
