Digestive problems

Sunday 30 June, 2013

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On this page: Food handling and infections ι Nausea and vomitting ι Heartburn (indigestion) ι Constipation ι Diarrhoea ι Other types of bowel irritation ι Reviewers


Food handling and infections

Cancer and cancer treatments weaken the body’s immune system by affecting white blood cells that protect against disease. As a result, your body can't fight infection as well as a healthy person’s body can. Good food hygiene, such as the basic guidelines that follow, is important for everybody. However, if you've had a bone marrow transplant or your white cell count is low, particularly during chemotherapy, extra care needs to be taken with food preparation as you'll be more susceptible to foodborne illness.

Most food poisoning results from improper handling and improper storage of food. Speak to your doctor or dietitian regarding any special food handling conditions which may apply to your stage of treatment.

Basic food safety guidelines

  • Wash your hands thoroughly with soap and water before you prepare or eat food.
  • Choose freshly cooked and freshly prepared foods. Take care when eating out, as it can be difficult to know whether food safety guidelines are being followed. When possible ask for meals to be made fresh and avoid foods that have been sitting for unknown periods of time.
  • Always thaw frozen food in the fridge or defrost in the microwave, rather than on the bench and don't re–freeze thawed food.
  • Keep raw meat covered, and keep it separate from cooked food or ready–to–eat food. Use separate utensils and chopping boards for raw meat and vegetables.
  • Thoroughly wash knives, cutting boards and food preparation areas with hot soapy water before preparing food.
  • Thoroughly wash and dry all fruit and vegetables, especially if eating them raw or juicing them.
  • Make sure all meat, poultry, fish and eggs are very well cooked.
  • Make sure foods are steaming hot when re–heated. Heat food for at least two to three minutes to above 70°C all the way through.
  • Hot food should be kept above 70°C, and cold food below 5°C.
  • Keep hot foods hot and cold foods cold, especially meat, chicken and seafood. Refrigerate leftover food immediately – don’t let it cool on the benchtop, and consume within 24 hours.
  • Check the use–by dates on packaged foods and dispose of any food that's out of date.

It's important to take care and potentially avoid the following high-risk foods, as they may contain bacteria or viruses that can cause foodborne illnesses:

  • Pre–made sandwiches or salads, sushi or food from food warmers or buffets.
  • Raw and undercooked seafood, meats and poultry. Make sure these foods are cooked thoroughly and reheated until they’re steaming hot.
  • Cold deli meats and chicken – packaged or unpackaged – unless reheated to steaming hot.
  • Foods containing raw or partially cooked eggs, e.g. homemade mayonnaise, mousse, egg nog.
  • Cold smoked seafood and ‘ready–to–eat’ peeled prawns.
  • Raw sprouts and commercial ‘ready–to–eat’ deli salads, including pre–cut fruit salads.
  • Pate, liverwurst and meat spreads.
  • Soft, semi–soft and surface ripened cheeses such as blue, brie, camembert, ricotta and feta.
  • Soft–serve ice creams and drinks made with soft–serve ice cream.
  • Unpasteurised dairy products such as raw goat’s milk, cheeses and yoghurts made from raw milk.

Nausea and vomiting

Feeling sick (nausea), with or without vomiting, is a possible side effect of cancer or its treatment. Vomiting sometimes follows nausea and may be brought on by treatment, stress, food odours, gas in the stomach or bowel, or motion sickness. The following information may help:

Stage 1: Small sips

If you have persistent vomiting, don’t try to force food down. Sip small amounts of liquid as often as possible. Try dry ginger ale, cold flat lemonade, soda water, Lucozade or chilled tomato juice. You might also find it helpful to suck a hard lolly, flavoured crushed ice cubes or an iceblock. If you can’t keep fluids down, and vomiting lasts for more than 24 hours, see your doctor because you may become dehydrated.

Stage 2: Introduce drinks slowly

If your vomiting has stopped, but you still feel nauseated and full, it's important to eat small, frequent meals. Hunger, or an empty stomach, can aggravate or prolong nausea. Start by drinking cold or iced drinks. Make up drinks that are half milk (or skim milk) and half water (or soda water). These mixtures are surprisingly settling and soothing. If you like sweet drinks, try a spoonful of ice cream in a glass of lemonade. You can also try diluted fruit drinks, Bonox, clear broth and weak tea. Jellies can be satisfying too.

Stage 3: Introduce solid foods

When you feel you can drink without discomfort, eat small amounts of solid foods, such as plain dry biscuits, toast or bread with honey, jam, Vegemite or Marmite. Try jelly and cooked cereals (such as lemon sago or boiled rice), and then try soft stewed fruits, such as apples, pears or peaches. Start drinking milk gradually and in small amounts, or try yoghurt, which is more easily digested. Have food in small amounts and have something to eat or drink at regular intervals.

Stage 4: Return to normal diet

As soon as you can, increase your food intake until your eating returns to a good level. Your doctor or dietitian may advise you to take additional nourishment (perhaps supplements) on your good days to make up for the days when you can’t eat properly. You may find the following foods difficult to tolerate when nauseous, so you may need to limit them (however it’s sometimes trial and error):

  • fatty or fried foods such as meats, fish, eggs or spicy stews and casseroles
  • full–cream milk, cream, strong cheese, dripping, lard, oils, dressings or mayonnaise
  • rich soup with cream or fat
  • potatoes cooked in fat, roast potatoes or potato chips
  • scones, pastry, rich cakes or cream cakes
  • chocolate biscuits, chocolate–coated nuts or peanut butter
  • filling foods, such as pasta, especially with spicy or oily sauces.

Heartburn (indigestion)

Cancer and some treatments can cause heartburn, which is a burning sensation in your oesophagus and throat due to reflux. The discomfort may cause you to reduce your food intake and lead to weight loss.

If you have heartburn, avoid or minimise foods that make it worse. Try not to eat large amounts of chocolate, highly seasoned spicy foods, high-fat foods (such as fried food, pastries, cream, butter and oils), tomato and tomato products, citrus fruits, coffee (including decaf), strong tea, soft drinks and alcohol.

Tips:

  • Avoid large meals, it's best to consume three small meals and three small snacks throughout the day.
  • Eat slowly and take the time to enjoy your meal. Avoid wearing tight clothing while eating, especially belts.
  • You may be able to eat more if you sip fluids in between meals, rather than drinking large amounts at meal time.
  • Be aware of foods or activities that may make your heartburn worse (see above).
  • Staying upright during and after eating and drinking can help. Sit upright for at least 30 minutes, and avoid lying down or activities that involve bending over (e.g. gardening) directly after eating.
  • Tell your doctor if indigestion or pain persists.

Constipation

Constipation is when your bowel motions are difficult to pass and infrequent. It may be caused by some medications, particularly strong pain medication, a diet low in fibre, lack of exercise, or by not having enough fluids to drink (dehydrated).

Important

When increasing the amount of fibre in your diet it's essential that you also increase fluids, to prevent the fibre making your constipation worse. Medication to help maintain comfortable bowel function is generally given to people taking codeine and morphine preparations. In these cases, eating extra dietary fibre may not help, and may make you feel overfull and uncomfortable.

It's important that you discuss constipation with your doctor who can prescribe medication if needed to help you maintain regular bowel function (e.g. suitable fibre supplements or laxatives).

Things to consider when you have constipation:

  • Drink plenty of fluids, at least eight to twelve glasses per day (2 to 3 litres), e.g. water, fruit juice, herbal tea, milk-based drinks or soup. This will help to keep stools soft.
  • Consume a variety of fibre–rich foods, such as wholegrain breads, cereals, pasta, fruit, vegetables (especially raw and unpeeled), nuts and seeds, legumes and pulses such as baked beans, lentils and chick peas.
  • Fresh orange, apple, pear or prune juice as possible alternatives to a fibre rich diet, especially for those people on fluid diets.

Try to get into a regular routine with your meals, which can help to regulate the digestive processes.

  • Avoid or reduce constipation due to radiotherapy by completely emptying your bowels before each treatment.
  • Try some gentle exercise, such as walking each day. Talk to your doctor, physiotherapist or exercise physiologist about the amount and type of exercise that's right for you. See our pages on exercise for people living with cancer.

Diarrhoea

Diarrhoea means your bowel motions are watery, urgent, and frequent. You may also get abdominal cramping. Diarrhoea may be caused by a number of different factors including treatment, medications, infections, food sensitivity or anxiety.

Diarrhoea induced by radiotherapy (usually to the pelvic area) doesn't necessarily require a change in diet. Dietary changes to help ease radiation induced diarrhoea haven't been well established; but it's important to maintain an adequate diet and replace lost fluids to prevent dehydration.

Things to consider when you have diarrhoea:

  • Take anti–diarrhoea medications as prescribed by your doctor.
  • Drink plenty of fluids to prevent dehydration. Water and diluted cordials are better hydrating fluids rather than high sugar drinks, alcohol, strong caffeine or very hot/cold fluids which may worsen diarrhoea.
  • Avoid highly spiced and fatty/oily foods.
  • Oral rehydration drinks may be needed to replace lost electrolytes. See your pharmacist for information on these products.
  • Talk to your dietitian about whether there are any individual dietary strategies that may help you if you have diarrhoea. Sometimes temporary intolerance to lactose (sugar found in milk) or fructose (sugar found in fruit) can cause diarrhoea. In such cases it may help to change to soy milk or low lactose milk until the diarrhoea resolves.
  • Consult your doctor before making any changes to your diet, and if you have ongoing diarrhoea. Your doctor can determine the cause, prescribe medication or refer you to a dietitian to provide suitable alternatives.

You may find it helpful to contact the National Continence Helpline on 1800 330 066. This is a free service which provides information and referrals to local services for people who are experiencing problems with continence.

Other types of bowel irritation

During chemotherapy or radiotherapy to your abdomen or pelvis, your intestines can become irritated leading to other problems such as abdominal discomfort or more flatus (wind) than usual. You may also need additional time to recover from surgery to the bowel area.

Tips:

Eat and drink slowly, take small mouthfuls and chew your food well to avoid swallowing air.

  • A low fibre diet may reduce bowel movement and irritation in the short term.
  • Reduce foods such as corn, beans, cabbage, onions, pickles and fizzy drinks which can produce wind.
  • Try some gentle exercise, such as walking, to encourage healthy bowel action.

Irritation of the large bowel (colitis) and rectum (proctitis) – may be experienced after radiotherapy to the pelvis. Some people feel the need to empty their bowels more often, perhaps without much result. Straining can cause discomfort, and there may be some blood or mucus in motions. These changes are usually temporary and will correct themselves.

In the short term, symptoms may be relieved by reducing your fibre intake and avoiding fatty or fried foods, rich gravies and sauces, sausages and spicy foods. Eat soft or cooked fruit, fine wholemeal bread (without coarse pieces of grain or seeds) and bran to provide soft bulk. Drink plenty of fluids.

Irritation of the small bowel (enteritis) – may occur because of chemotherapy or radiotherapy to the abdomen or pelvis. You may experience some abdominal discomfort (like cramps or wind pain), episodes of fluid and pale bowel motions and more flatulence (wind) than usual. These changes usually correct themselves within a week or so after treatment. Speak to your doctor if you experience symptoms for more than a week.


Reviewed by: Jenelle Loeliger, Head - Nutrition Department, Peter MacCallum Cancer Centre, VIC; Kate Aigner, Cancer Information Consultant, Cancer Council Helpline ACT; Ian Anderson, Consumer; Dr Anna Boltong, (Clinical Dietitian), Unit Head, Cancer Information and Support Service, Cancer Council Victoria, VIC; Clare Hughes, Nutrition Program Manager, Cancer Council NSW; Bridget Kehoe, Public Health Coordinator (Nutrition and Physical Activity), Cancer Council QLD; Steve Pratt, Nutrition and Physical Activity Manager, Cancer Council WA; and Roswitha Stegmann, Helpline Nurse, Cancer Council WA.
Updated: 30 Jun, 2013