Bowels: Everybody poops.
Not the most glamorous of subjects but everyone poops in one way or another. It is well known that chemotherapy can cause diarrhoea, constipation and everything inbetween. In other words, it screws up your gut.
This is due to many reasons.
It can be as a direct side effect of the chemotherapy. For me, about 2-3hours after chemo I would have a full colonic clear out. I didn’t find it painful, just intense and nothing can quite prepare you for the smell of the “chemo sh*ts”, not even the toilet pits at a festival on day 5. It’s a smell that will stay with me (and unfortunately my partner) for the rest of my days.
As mentioned in my other posts, the cells that line your gut are fairly fast growing and so are easily affected by chemo, this can cause irritation and again can cause diarrhoea, or constipation…
Your gut biome (natural bugs within your gut) is so important for good gut health. Read this fascinating BMJ article here. (This is also a very interesting article about how they think your gut biome can help fight against cancer - read it here.) Unfortunately chemo can nuke these good bugs and so that can cause changes in your bowels too.
There is some evidence suggesting that before starting chemo if you have a diverse gut biome (lots of different types of bugs/good bacteria) you’re less likely to suffer from toxic effects of chemotherapy and it may help the chemotherapy to be more effective. A great way to improve your gut biome is through “live yoghurts”, Kefir (which in itself seems to have anti cancer, anti allergy, and numerous other benefits - see article here.) and you can also buy specific probiotics (these have friendly gut bacteria in them) and prebiotics (these have fibre/goodies in that feed the good gut bacteria). My friend very kindly bought me Symprove which has really helped my gut post chemo.
Finally some of the anti sickness medications you may be prescribed can cause constipation. The most common one being Ondansetron.
So what can you do?
With regards to constipation;
Ensure your diet has lots of fibre (think pulses, leafy green veg etc)
Drink plenty of water
Try and keep active (walking is great)
Drugs;
Lactulose
A sugary liquid that you can take twice a day (~15-30ml). It is very gentle and keeps water in your bowel so making your stools bigger but softer and easier to pass.Macrogol
Similar to lactulose but a sachet that you mix with water - come in different flavours.Senna or Bisacodyl
Stimulant laxatives - they get your bowel moving. You typically take these at night time. They can cause some stomach cramps.
With regards to diarrhoea;
Try and avoid high fibre foods
Some people find lactose can worsen diarrhoea so try to avoid dairy products if this applies to you
Drink plenty of water
Drugs;
Rehydration sachets if you are dehydrated
Loperamide
This works by slowing the bowel down, can cause constipation if too much is used.
Here are some really useful websites…
NHS
On constipation
NHS
On dehydration
Guardian
Article/information about the gut microbiome
ISAPP
Useful information on probiotics, prebiotics and everything inbetween
BMJ
Interesting article about the gut microbiome
NCBI
Interesting article about the gut microbiome and the influence on cancer and immunity
NCBI
Interesting article on Kefir and the effect on the microbiome