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Bowel Problems: Prevention and Treatment

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Bowel Problems: Prevention and Treatment Bowel Problems: Prevention and Treatment A Bowel Changes During Treatment There are 7 types of stool. Types 3 and 4, considered normal stool, is best for comfort and overall health. Cancer can change your normal bowel patterns, depending on the type of cancer you have and your How do bowel movements happen? treatment plan. These changes can affect how you feel and your ability to go about your daily activities. If you The organs in the body that help digest food are part have constipation or diarrhea, this guide can help. You of the digestive system, also called the gastrointestinal will learn the symptoms and causes of bowel problems (GI) tract (Figure 1). After food passes through the and how to treat them. stomach and small intestine, the remaining material is mostly waste products in liquid form. This liquid Normal Bowel Movements stool then enters the colon where water is absorbed for use in the body. The last portion of the colon empties Body waste (called stool) is usually medium brown, stool into the rectum. The rectum acts like a pouch to soft and formed. “Normal” depends on the person. hold stool until a bowel movement happens. During Only you know what is normal for you. Is your stool a bowel movement, stool passes through the anus and too difficult to pass? Do you have bowel movements out of the body. New food and fluids can then move more or less frequently than before? Bristol Stool Chart Type 1 Separate hard lumps Severe constipation Type 2 Lumpy and sausage like Mild constipation A sausage shape with cracks Normal Type 3 in the surface Like a smooth, sausage Normal Type 4 or snake Soft blobs with Lacking fiber Type 5 clear-cut edges Mushy consistency Mild diarrhea Type 6 with ragged edges Liquid consistency with Severe diarrhea Type 7 no solid pieces Created by the Bristol Royal Infirmary, Bristol, England, 1997 3 Figure 1 GI Tract through the digestive system and supply the body with Constipating Medicines nutrients. If you take constipating medicines, such as opioids for pain or Zofran® for nausea, begin to take stimulant How often should I go? laxatives and stool softeners daily. Check with your Normal frequency is different for each person, but doctor or nurse about how much to take per day. See should happen in a consistent pattern day to day. page 11 for more information. Bowel movements usually happen after a big meal when contents in the GI tract move down to make Opioid pain medicines slow down the movement room for incoming food. For example, many people of stool through the GI tract and will cause stool to have a bowel movement in the morning after eating harden. Common opioids prescribed are: breakfast. • Morphine (MS Contin®) The frequency of how often you go is related to how • Hydrocodone (Norco®) much food you eat. Everyone is different, but a general • Oxycodone (OxyContin®) guideline is: • Fentanyl (Duragesic®) • If you eat 3 meals a day, expect a bowel movement • Hydromorphone (Dilaudid®) every day. • If you eat half your normal amount of food, expect Other medicines may also cause constipation, a bowel movement every other day. including: • If you eat one-third of the amount, expect a bowel • Some anti-nausea drugs such as ondansetron movement every third day. (Zofran®) • Some anti-depressants such as fluoxetine (Prozac®) Constipation and amitriptyline (Elavil®) Constipation is the infrequent or difficult passing • Antihistamines of hard, dry stool. • Calcium channel blockers • Diuretics (water pills) Causes • Iron supplements • Not drinking enough fluid • Muscle relaxers • Not eating enough food • Parkinson’s disease medicines • Not enough fiber in the diet • Calcium-based antacids or calcium supplements. • Lack of physical activity Magnesium-based products may cause softer • Constipating medicines and more frequent (loose) stools. If the product is a combination of calcium and magnesium, 4 Figure 2 High Impaction Figure 3 Low Impaction it may affect bowel movements. Check the Impactions ingredient label. An impaction is a case of severe constipation. It is a Always read the label on over-the-counter products build-up of stool either in the upper or lower part of and understand what you are taking and why. the colon. Sometimes your health care provider may tell you to take over-the-counter medicine differently than There are several ways to diagnose impactions. An the package label says. Always follow your provider’s impaction can happen if constipation is not treated. instructions. Call your health care provider if you think you may have an impaction. Prescription medicines can cause changes in your bowel. Check with your doctor or pharmacist about High and low impactions have different symptoms how your medicines may affect your bowel. (Figures 2 and 3). Symptoms of Constipation High Impaction Symptoms • No bowel movement for 3 or more days • No bowel movement for 5 or more days • Straining during a bowel movement • Not being able to eat • Hard stool • Pain in the belly or the belly becoming swollen and possibly hard • Gas • Passing liquid stool that is seeping around formed • Bloating stool Report the following symptoms to your doctor: Low Impaction Symptoms • No bowel movement for more than 3 days • No bowel movement for 5 or more days • Abdominal pain, cramping • Not being able to pass stool that you feel in the • Fever rectum • Nausea and vomiting • Not being able to sit comfortably, because it feels like you are sitting on something • Pain in the belly • Passing liquid stool that is seeping around formed stool 5 Preventing Constipation Laxatives and Stool Softeners • Fluid: Drink at least 2 quarts (equal to 64 ounces) Stimulant laxatives and stool softeners are medicines of non-alcoholic fluids each day. Half of your daily that can help you have a bowel movement. Stimulant fluid intake should be from non-caffeinated fluids, laxatives help move stool down the GI tract and stool like water. softeners help keep fluid in the stool. Some are in pill • Food: Eat a well-balanced diet that includes: form while others are in liquid. Many are available without a prescription. – Items from all food groups: milk and milk products, lean meat and beans, vegetables, The chart on page 11 provides information on laxatives fruits and whole grains. and other products available to help pass stool. Your – 30-40 grams of fiber a day. Good sources of care team can help you decide which product is best dietary fiber include pears, raspberries, for you. Keep in mind that many store brand or blackberries, green leafy vegetables, peas, generic products work equally as well as name brand beans, lentils and foods made with whole products and often cost less. grains. Ask your doctor or dietitian about adding flaxseed or chia seeds to yogurt, cereal Contact your doctor, nurse or pharmacist if you have or oatmeal. questions. – Foods that may help you have a bowel movement, like prunes or high-fiber cereal Treating Constipation (such as General Mills Fiber One®). Follow these tips to help treat constipation. • Fiber: You may need to take medicinal fiber. • Drink a hot or warm liquid after eating a meal. For Follow these steps: mix 6.8 grams of Metamucil® some people, drinking a hot liquid helps to bring or 1 tablespoon of Citrucel® in 8 ounces of water on a bowel movement. For example, drinking and drink. Next, drink 8 more ounces of fluid, like senna-based hot tea can help relieve constipation. water. Do not take medicinal fiber if you have a Senna is an herb that is approved by the Federal history of blockages in the bowel, or if you are on Drug Association (FDA) for use as an over-the- chemotherapy that causes diarrhea. counter laxative. Several senna tea brands are available in the tea or natural remedy section • Activity: Daily physical activity helps keep the of grocery and drug stores. Avoid tea labeled as digestive system active. Ask your doctor about how dieter’s tea. This tea contains herbal ingredients much physical activity is best for you. that can cause pain, gas and cramping leading to • Timing: Go to the bathroom right away when you diarrhea. feel the urge to have a bowel movement – don’t wait. • If you do not have a bowel movement by 4 p.m. on the day you expect, follow these guidelines. 6 For constipation: Several generic brands of combination stool softener and stimulant laxatives – Drink 4 ounces of prune juice followed by 8 Causes ounces of hot liquid. Hot or warm tea is a good • Anxiety choice. Avoid drinking caffeinated coffee. • Fried and spicy foods – If you do not have a bowel movement by • Food allergies bedtime, take milk of magnesia. This gentle • Impaction - See page 5. laxative is available over-the-counter in liquid or pill form. Take 2 tablespoons or 2 pills of • Infections or parasites in the GI tract milk of magnesia at bedtime with 8 ounces of • Irritable bowel syndrome (IBS) water. • Inflammatory bowel disease (IBD) – If you do not have a bowel movement by • Increasing your daily intake of fiber too quickly breakfast the next morning, you may repeat the • Medicines and medical treatment dose of milk of magnesia and 8 ounces of water every 6 hours until you have a bowel movement. If you have kidney problems, ask Medicines and Medical Treatment That May your health care provider before repeating the Cause Diarrhea dose. • Broad spectrum antibiotics • You may need an enema if you feel like you have • Laxatives a large amount of stool in your bowel. Speak with • Radiation treatment to the abdomen your nurse or doctor before using an enema.
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