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Incontinence | Diarrhoea | Wind | Diet | Key points about managing bowel symptoms | What if bowel cancer returns?
Treatment for bowel cancer can affect how your digestion and bowel work. These changes can be difficult to adjust to at first. They usually improve over time, but sometimes may be ongoing and require specialised help. If you experience any of these problems, talk to your GP, specialist doctor, specialist nurse or dietitian.
Cancer care pathways
For an overview of what to expect during all stages of your cancer care, from diagnosis to treatment and beyond, read or download the Guide to Best Cancer Care for bowel cancer. This resource is also available in Arabic, Chinese, Greek, Hindi, Italian, Tagalog and Vietnamese – see details on the site.
Incontinence is when a person is not able to control their bowel or bladder. It may be caused by different types of treatment for bowel cancer.
“I literally had to sprint to the toilet when I had to go. At six months, the sprinting slowed down. At twelve months, I no longer had to sprint.” – Richard
The movement of waste through the large bowel can become faster after surgery or radiation therapy. 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 movements. Bowel surgery or radiation therapy 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).
This is when urine leaks from your bladder without you being able to control it. Bladder control may change after surgery or radiation therapy. For example, radiation therapy can irritate the lining of your bladder, because the bladder is located near the large bowel. Some people find they need to urinate more often, need to go in a hurry or don’t fully empty the bladder.
Ways to manage incontinence
While you may feel embarrassed if you have bowel or bladder changes, there are ways to manage the symptoms. Incontinence usually improves in a few months, but sometimes take years.
- Talk to your surgeon or GP about available treatments. They may refer you to the hospital continence nurse or physiotherapist, who can suggest exercises to strengthen the pelvic floor muscles.
- Call the National Continence Helpline on 1800 33 00 66 to talk to a continence nurse about continence aids, if needed, or visit the Department of Health website for more information.
- Find out the location of public toilets near where you are. Visit the National Public Toilet Map online or download the App version from the App Store (Apple phones) or Google Play (Android phones).
- The Continence Foundation of Australia's Improving Bowel Function After Bowel Surgery booklet provides helpful tips about managing bowel problems.
Diarrhoea is the frequent passing of loose, watery faeces. It can also cause abdominal cramping, wind and pain. Different types of treatment can cause diarrhoea:
- Surgery – If you have had part of your bowel removed, your bowel movements may be looser than you were used to. This is because the bowel absorbs water to form faeces. With a shorter bowel, the faeces don’t form as solidly as before. This may be ongoing, but there are many ways of managing diarrhoea.
- Radiation therapy – Diarrhoea is a common side effect of radiation therapy. It can take some weeks to settle down after treatment has finished. For a small number of people, diarrhoea is ongoing.
- Chemotherapy – This treatment can cause diarrhoea and nausea. These side effects will go away after treatment and you can gradually return to a normal diet.
Ways to manage diarrhoea
Having diarrhoea can make you feel tired. Try to rest as much as possible and ask family or friends to help out with housework. Talk to your doctor and nurses about ways to control diarrhoea, such as using over-the-counter medicines and changing your diet. You may also be referred to a dietitian or to a physiotherapist who specialises in bowel function. If diarrhoea continues for a few days, see a doctor.
“I had diarrhoea for a few weeks but it improved with medication.” – Emma
Some ways to manage diarrhoea include:
- Eat three small meals a day and snack often.
- Choose low-fibre foods that are easier to digest, such as bananas, white rice, white pasta, white bread, potatoes, white fish and steamed chicken without skin.
- Add well-cooked vegetables without seeds, husks or skin, such as carrots, potato and pumpkin, to your meals.
- 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.
- Avoid foods that increase bowel activity, e.g. caffeine; alcohol; spicy, fatty or oily foods; high-sugar fluids such as juice and soft drink; artificial sweeteners.
- Don’t eat too many raw fruits and vegetables, wholegrain breads and cereals, or legumes (e.g. lentils, chickpeas), as they may make diarrhoea worse.
- Avoid dairy foods if they cause problems, or try low-lactose or soy-based dairy products.
- Watch for warning signs of dehydration. These include a dry mouth, dark yellow urine, dizziness and confusion. If dehydration is left untreated, it can be dangerous.
- Drink plenty of water to avoid becoming dehydrated and consider having a rehydration drink.
- If your anus becomes sore, clean area with warm water and a soft cloth. Ask your treatment team to recommend a cream.
Many people who have treatment for bowel cancer, especially surgery, find that it gives them wind, commonly referred to as gas or farting. This is usually temporary and improves with time.
“Three months after the ileostomy, I went in for the reversal surgery. You have to stay in hospital until you pass wind, which took six days. Passing wind will never lose its amusement.” – Richard
How to manage wind
The following tips are a guide only, as foods can affect people differently:
- Limit the foods that cause wind. These might include fruits and vegetables high in carbohydrates (e.g. broccoli, apples), which cannot be digested and absorbed in the bowel.
- Try chewing charcoal tablets, eating natural yoghurt and drinking peppermint tea.
- Cut your food into small, bite-sized pieces.
- Chew your food slowly and thoroughly.
- When you have a drink, take small sips and don’t use a straw.
- Talk to your doctor about what types of light exercise you can do to relieve bloating and wind.
- Avoid foods that increase gas, e.g. eggs, legumes such as lentils and chickpeas, large serves of dairy products, fizzy drinks, sugar-free foods.
- Don’t eat too many raw fruits and vegetables.
Food after treatment
Immediately after treatment – particularly surgery – you may be on a modified diet. During and after recovery from treatment, you may find that certain foods upset your bowel, and cause diarrhoea or wind. What you are able to eat might depend on the type of surgery you’ve had, how much of your bowel was removed and whether you have a stoma.
As foods can affect people differently, you will need to experiment to work out which foods cause problems for you. It is better to limit – not eliminate – these foods in your diet, as you may find that what you can handle improves over time. When returning to your usual diet, introduce one food at a time. If something causes a problem, try it again in a few weeks to see if your response has improved.
Keeping a diary of what you eat and how it affects you can help. Make a note of the foods that cause constipation or diarrhoea. Share this information with the health care team, which can help them figure out how to manage any issues. Your ability to handle different foods usually gets better with time but can take many months.
“When I first got put back together after the ileostomy, processed food really messed with me. The more processed it is, the slower my body deals with it. Some of the things I loved – pizza, processed meat, bread, red meat and potato – play with me. The greener the better – salads, fruit, fish, chicken really make me feel sensational.” – Richard
Ways to manage stoma blockages
If you have a stoma, you may need to change what you eat in the first few weeks to help the stoma settle. Nuts, seeds and very fibrous foods can block the stoma. The amount of stoma output will vary depending on how much you eat and when you eat. By trial and error, you might work out which particular foods irritate the stoma, but these vary considerably between people. Most people with a stoma return to their usual diet. If you have concerns, ask your doctor or stomal therapy nurse to refer you to a dietitian.
Here are some tips to manage stoma blockages:
- Eat regular meals.
- Avoid eating a large amount of food at one time.
- Try to maintain a balanced diet so your body is well nourished.
- Aim to drink 8–10 glasses of fluid a day so you stay well hydrated.
- Cut food into small, bite-sized pieces, and chew slowly and thoroughly.
- If you have trouble eating a certain food, talk to a dietitian about alternatives.
- You may find cooked food easier to digest.
- Limit foods that are more likely to cause blockages. These include high-fibre foods, raw vegetables, fruit and vegetable skins, nuts, seeds, kernels (e.g. corn, popcorn) and sausage skins.
- Have small amounts of a new food. If it doesn’t irritate the stoma, try more next time.
- Massage your belly and the area around the stoma. Lie on your back and pull your knees up to your chest and roll from side to side.
Key points about changes to bowel function
After treatment for bowel cancer, most people find their bowel function changes. You may have trouble controlling your bowel or bladder, have diarrhoea, or suffer from wind.
- Stomal therapy nurses and stoma associations can provide support and information to help you adjust to life with a stoma.
- There are many ways to manage incontinence, and changes to bowel and bladder function. For support and information, talk to your treating doctors.
- Drinking plenty of fluid throughout the day will help avoid dehydration and reduce constipation and blockages.
- You may need to change what you eat, especially if the diarrhoea or wind is ongoing, or if you have a stoma blockage.
- A dietitian can give you advice on removing certain foods from your diet and tell you if and when to reintroduce them.
What if bowel cancer returns?
It is important to have regular check-ups so that if cancer does come back, it can be found early.
You will usually have a physical examination and you may have blood tests (including checking CEA levels), scans and colonoscopies. Your doctor may want to see you two to four times a year for the first year, twice a year for the next few years, and then yearly for a few years. Check-ups will become less frequent if you have no further problems. Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.
For some people, bowel cancer does come back after treatment, which is known as a recurrence. If the recurrence is confined to the bowel and nearby lymph nodes, it may be possible to remove it with surgery. Removing the tumour can help relieve symptoms and, in some cases, may stop the cancer.
If bowel cancer has spread beyond the bowel (advanced or metastatic bowel cancer), you may be offered treatment, such as surgery, chemotherapy, targeted therapy or radiation therapy, to remove the cancer or help control its growth. If your bowel becomes blocked, you will need urgent treatment.
Expert content reviewers:
A/Prof David A Clark, Colorectal Surgeon, Royal Brisbane and Women’s Hospital, and The University of Queensland, QLD, and The University of Sydney, NSW; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare Gold Coast, QLD; Dr Hooi Ee, Specialist Gastroenterologist and Head, Department of Gastroenterology, Sir Charles Gairdner Hospital, WA; Annie Harvey, Consumer; A/Prof Louise Nott, Medical Oncologist, Icon Cancer Centre, Hobart, TAS; Caley Schnaid, Accredited Practising Dietitian, GenesisCare, St Leonards and Frenchs Forest, NSW; Chris Sibthorpe, 13 11 20 Consultant, Cancer Council Queensland; Dr Alina Stoita, Gastroenterologist and Hepatologist, St Vincent’s Hospital Sydney, NSW; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital, ACT; Richard Vallance, Consumer.
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The information on this webpage was adapted from Understanding Bowel Cancer - A guide for people with cancer, their families and friends (January 2021). This webpage was last updated in March 2021.