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 help. If you experience any of these problems, talk to your GP, specialist doctor, specialist nurse or dietitian.
Surgery for rectal cancer can lead to symptoms such as faecal incontinence, constipation or frequent bowel movements. This is known as low anterior resection syndrome (LARS), and it can last for months or years. If you have ongoing bowel effects after rectal surgery, talk to your surgeon. Ways to improve bowel
function may include changing what you eat, taking medicines and having physiotherapy.
Your guide to best cancer care
A lot can happen in a hurry when you’re diagnosed with cancer. The guide to best cancer care for bowel cancer can help you make sense of what should happen. It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.
Read the guide
Incontinence
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.
Faecal incontinence
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).
Urinary incontinence
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 for more information.
- Find out the location of public toilets near where you are. The National Public Toilet Map is a great resource, and you can also download the app version.
Diarrhoea
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. 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.
- 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, including caffeine, alcohol, spicy, fatty or oily foods, high-sugar fluids such as juice and soft drink, and 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 the area with warm water and a soft cloth. Ask your treatment team to recommend a cream.
Wind (flatulence)
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.
Ways 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, including eggs, legumes such as lentils and chickpeas, large serves of dairy products, fizzy drinks and 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. 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, and 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 your 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.
Follow-up appointments
It is important to have regular check-ups so that if cancer does come back, it can be found early. Check-ups have been found to improve survival after surgery for bowel cancer. You will usually have a physical examination and you may have blood tests, scans and colonoscopies.
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), 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.
Question checklist
Asking your doctor questions will help you make an informed choice about your treatment and care. You may want to include some of the questions below in your own list:
Diagnosis
- What type of bowel cancer do I have?
- Has the cancer spread? If so, where has it spread? How fast is it growing?
- Are the latest tests and treatments for this cancer available in this hospital?
- Will a multidisciplinary team be involved in my care?
- Are there clinical guidelines for this type of cancer?
Treatment
- What treatment do you recommend? What is the aim of the treatment?
- Are there other treatment choices for me? If not, why not?
- Will I need a stoma? If so, will it be temporary or permanent?
- Will you refer me to a stomal therapy nurse?
- If I don’t have the treatment, what should I expect?
- I’m thinking of getting a second opinion. Can you recommend anyone?
- How long will treatment take? Will I have to stay in hospital?
- Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
- How will we know if the treatment is working?
- Are there any clinical trials or research studies I could join?
Side effects
- What are the risks and possible side effects of each treatment?
- Will I have a lot of pain? What will be done about this?
- Can I work, drive and do my normal activities while having treatment?
- Will the treatment affect my sex life and fertility?
- Should I change my diet or physical activity during or after treatment?
- Are there any complementary therapies that might help me?
After treatment
- How often will I need check-ups after treatment?
- If the cancer returns, how will I know? What treatments could I have?
Understanding Bowel Cancer
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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 (2021 edition). This webpage was last updated in June 2021.