What is diarrhea and when does it occur?
is generally described as abnormally frequent bowel movements that are
more fluid than usual. Patients describe it based on their past and present
experiences; therefore, what is normal for one person may be considered
diarrhea to another. Often, health professionals characterize diarrhea
as 4 or more loose stools per day. It is a common side effect experienced
by many patients with cancer.
Diarrhea may be caused by:
- lactose intolerance
- bacterial infection
- damage to intestinal wall
- hormone-producing tumors (including certain types of pancreatic neuroendocrine
- inflammation or ulceration of the bowel
- surgery that has shortened the gut causing malabsorption
- pancreatic enzyme insufficiency
- radiation therapy to the lower abdomen
- certain medications
People may experience different
types of diarrhea. Clay-colored stools are often a result of problems
with or obstructions of the biliary tract. The biliary tract is the drainage
system for the gall bladder, pancreas and liver. Biliary tract blockages
are common for patients with pancreatic cancer.
Floating stools often result from poor absorption of nutrients or changes
in the diet, such as increased fiber. Malabsorption is common for patients
with pancreatic cancer because the pancreas may not be able to produce
or release enough pancreatic enzymes to aid in proper food digestion.
If a patient experiences diarrhea, a journal may be helpful to track the
onset, frequency, duration, stool consistency and self-care measures taken
to control it. It is helpful to share this written record with the doctor
or dietitian to help devise a plan to manage the diarrhea. Since diarrhea
can cause dehydration, it may also be helpful to keep track of fluid intake.
Taking pancreatic enzyme replacement medications with meals is a topic
to discuss with the doctor. Pancreatic enzymes break down carbohydrates,
proteins and fats from food. If the levels of enzymes produced naturally
by the pancreas are insufficient due to the cancer itself, surgery or
other treatments, additional enzymes may be needed. The doctor will prescribe
the type, dosage and administration schedule based on individual need,
symptoms and quantity of food intake. Before starting the use of any medicines,
talk to the doctor.
Regardless of the cause of diarrhea, the following diet modifications
may help decrease the volume and frequency of stools.
The following foods
may exacerbate diarrhea:
The following foods are less likely to exacerbate diarrhea:
- Fatty, greasy or fried foods, including high fat meats or cheeses,
whole or 2% milk, rich desserts, many fast foods and foods with added
oil, butter, margarine, sour cream, cream cheese or salad dressing.
- High intake of insoluble fiber food sources during occurrences of
diarrhea. Foods such as whole grain breads/cereals, raw fruits
with thick peels, raw vegetables and nuts can make foods move faster
through the intestines.
- Gas-forming foods, including vegetables in the cabbage or onion family,
dried beans, corn, popcorn and chewing gum. If carbonated beverages
are used, leaving them open for at least 10 minutes prior to drinking
may help reduce.
- Foods high in sugar may cause diarrhea due to dumping syndrome. The
symptoms of dumping syndrome include watery diarrhea or feelings of
low blood sugar that occur within 30 minutes to 2 hours after eating
high-sugar foods. Symptoms of low blood sugar include flushing, faintness
- Hot liquids.
- Products made with regular milk if lactose intolerance is present
Other supportive care techniques:
- Lower fat food choices. Fat-free or reduced fat products may
relieve symptoms of gas, bloating and diarrhea.
- Soluble fiber foods, such as oat fiber and high-pectin foods like
applesauce and bananas, can help thicken stools.
- If lactose intolerance is present or develops, it may help to use
plant based milk alternatives, such as soy or rice milk, or dairy products
with added lactase (Lactaid®). Lactaid® Fast Act caplets or chewable
tablets can also be taken with dairy products instead of milk alternatives.
- Plan to eat 5-6 small meals and snacks each day.
- Talk to the healthcare team including the doctor or registered dietitian
about pancreatic enzymes or other anti-diarrhea medications that may
- Drink plenty of fluids.
- Over-the-counter anti-diarrhea medicines:
- Loperamide: Slows down the time it takes food to travel through
the intestinal tract (e.g., Imodium A-D® and Imodium®).
- Adsorbents: Attract diarrhea-causing substances from the digestive
tract (e.g., Pepto-Bismol® and Kapectolin®).
- Absorbents: Make stools more solid by adding bulk (e.g., Metamucil®,
Benefiber® and Konsyl®).
- Prescription anti-diarrhea medicines:
- Opioids: Slow down the time it takes food to travel through
the intestinal tract (e.g., Lomotil® and tincture of opium).
- Anticholinergics: Relieve spasms and cramping (e.g., atropine,
belladonna and scopolamine).
- Somatostatin analogues: Reduce the secretion of extra fluid
and help the body reabsorb valuable water and electrolytes.
They also slow down the time it takes food to travel through the intestinal
tract (e.g., Sandostatin®).
- The use of probiotics appears helpful in improving tolerance of and
support for treatment and radiation-related diarrhea. Further research
is needed to confirm the effects of probiotics when used in patients
with pancreatic cancer. Sources of probiotics include foods such as
yogurt, kefir, buttermilk, tempeh and sauerkraut, therapeutic foods
such as DanActive™, Activia™ and dietary supplements such as Culturelle®
Diarrhea and Dehydration
Diarrhea can cause dehydration.
Dehydration results in the loss of fluids and electrolytes, including
sodium and potassium, from the body.
Here are some suggestions to avoid dehydration:
- Drink 48–64 ounces of mild, clear liquids throughout the day to replace
fluid loss from diarrhea. Liquids are better tolerated at room
- Avoid beverages that contain caffeine such as coffee, tea and sodas.
- Drink an additional cup of fluids for each loose bowel movement.
- Check with the doctor to see if sports drinks or electrolyte replacement
drinks (e.g., Gatorade®, G2®, Pedialyte® or Ceralyte70®) may be beneficial.
- Replace lost sodium with slightly warm broth or soup, crackers, pretzels,
and sports drinks or electrolyte replacement drinks.
- Replace lost potassium by drinking fruit juices, sports drinks or
electrolyte replacement drinks, or by eating peeled potatoes and bananas.
The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, see a doctor immediately! The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site. In addition, please note that any personal information you provide to the Pancreatic Cancer Action Network's associates during telephone and/or email consultations may be stored in a secure database to assist the Pancreatic Cancer Action Network, Inc. in providing you with the best service possible. Portions of the constituent data stored in this database may be used to inform future programs and services of the Pancreatic Cancer Action Network, Inc., and may be provided in aggregate form to third parties to guide future pancreatic cancer research and treatment efforts. The Pancreatic Cancer Action Network, Inc. will not provide personal identifying information (such as your name or contact information) to third parties without your advanced written consent. 110913