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Gastrointestinal disturbances This Infosheet explains what gastrointestinal disturbances are, what causes nausea, vomiting, constipation and diarrhoea in myeloma patients, how they are treated and some tips for self-management. What are gastrointestinal a few days) or chronic (persisting for disturbances? longer periods of time, usually more Gastrointestinal (GI) disturbances than two weeks). are issues involving your stomach Severe or long-term vomiting, and intestines. This can include constipation or diarrhoea can lead nausea, vomiting, constipation and to more serious conditions, so any diarrhoea. These are very common vomiting or change in your normal side effects in myeloma patients, bowel habits should be reported and can upset normal day-to-day life to your doctor or nurse. If you feel and be distressing to live with. awkward or embarrassed discussing GI disturbances can be acute your bowel habits, try to remember (lasting for a short time only, such as that your doctor and nurse will be Myeloma Symptoms and Infosheet complications Series Infoline: 0800 980 3332 1 used to talking about it and that If you find blood (either bright red they are there to help prevent and or dark and like coffee grounds) in manage any side effects of myeloma your vomit you should seek medical and its treatment. advice immediately. What are the causes of nausea and Nausea and vomiting in myeloma patients? vomiting Nausea and vomiting are very common in myeloma patients. They What are nausea and vomiting? can be due to a number of reasons. Nausea is a feeling of queasiness, Myeloma treatment and unease and discomfort in the upper supportive treatment stomach, with an urge to throw up or be sick (vomit). Treatment for myeloma is the most common cause of nausea You may not necessarily vomit if you and vomiting in myeloma patients. have nausea. They are common side effects of chemotherapy drugs, such as What are the symptoms of nausea cyclophosphamide and melphalan, and vomiting? and other anti-myeloma drugs, such The symptoms of nausea and as bortezomib. vomiting include: Some supportive treatments can Feeling like you need to vomit or also cause nausea and vomiting. actually vomiting For example, some people can feel Queasiness sick during or after radiotherapy. Antibiotics and some painkillers can Dizziness cause nausea and vomiting too. Excessive sweating and If you have previously been affected clamminess by nausea and vomiting during Dry mouth treatment, you may anticipate Severe or persistent vomiting can that you will experience the same lead to: symptoms again. This can induce a type of nausea called anticipatory Dehydration nausea. Stomach pain Damage to the throat 2 www.myeloma.org.uk Infection Treatment for other illnesses or Certain bacterial and viral infections conditions may also cause nausea cause nausea and vomiting. These and vomiting. You can check infections are often contagious, so whether any other treatment you if you have been around others who are having can cause nausea and have had stomach bugs it is not vomiting by consulting the patient uncommon to pick up an infection information leaflet (PIL) included too, especially because myeloma in the drug pack. You should make patients have a higher risk of your doctor or nurse aware of any developing infections. other treatments you are taking for other illnesses or conditions. Other symptoms of an infection include diarrhoea, abdominal How are nausea and vomiting cramps and pain, a high temperature treated? and loss of appetite. Anti-emetics For more information see the Infection and Nausea and vomiting are usually myeloma Infosheet from Myeloma UK treated with anti-emetics, for example metoclopramide, Stress, anxiety and nervousness granisetron and ondansetron. They Strong emotions, in particular stress, will be prescribed along with your anxiety and nervousness, can make myeloma treatment to prevent or you feel sick or vomit. minimise these side effects. You should take your anti-emetic For more information see the Infopack for medications regularly as prescribed. living well with myeloma from Myeloma UK Do not wait until you feel sick, as the drugs won’t be as effective this way. Pain If you find the anti-emetics you have Severe pain can cause nausea and/ been prescribed are not effective or vomiting. when taking them as prescribed, ask to try a different one as there are Other illnesses and conditions several types available. Other illnesses and conditions can Other treatments be responsible for causing nausea and vomiting, for example, diabetes If your nausea and/or vomiting or travel sickness. are not directly caused by your myeloma treatment, you may be Infoline: 0800 980 3332 3 given treatments other than anti- sick, try putting light perfume emetics to help. This could include onto a handkerchief that you can painkillers, antibiotics or relaxation use to help mask the smell aids like complementary therapies. Certain scents may help, for example lavender. Speak to a Tips for self-management complementary therapist who It is important to keep drinking should be able to recommend as vomiting can dehydrate you. some aromatherapy scents to Allow your stomach to rest after help with your nausea vomiting then sip drinks such as Try to take your mind off how still or sparkling water or fizzy you feel – talk to people, watch a drinks film or listen to soothing music to Ginger may help settle your distract yourself stomach. Try ginger tea, non- Relaxing breathing exercises or alcoholic ginger beer/ale or ginger lying down in a darkened room biscuits may help to reduce feelings of Mint can also help with nausea. nausea Try mint tea, mints or chewing Fresh air may help – try sitting gum outside or near an open window Eat little and often. Snacking on Calm your anxiety or stress with plain, cold or room-temperature relaxation techniques food may be more palatable than hot meals. If you can’t face eating If vomiting is severe, fluid can be solid food, high calorie drinks may replaced by special preparations be more tolerable available through your GP or from a chemist Avoid spicy, fatty or acidic foods Avoid your favourite foods to prevent you associating them with nausea and vomiting Avoid strong smells if they exacerbate your nausea, for example avoid cooking or keep the window open during food preparation If hospital smells make you feel 4 www.myeloma.org.uk A feeling that you have not Constipation completely emptied your bowels What is constipation? If constipation is not treated it can cause more severe symptoms, Constipation is defined as having including: difficulty emptying your bowels. When you are constipated, bowel Swollen, painful stomach, often movements occur less often than accompanied by stomach cramps they would normally and they may Loss of appetite be dry, hard and painful. Nausea It is important to know what your Vomiting normal bowel pattern is because constipation is relative to your usual Excessively runny diarrhoea – this habits and this varies between may occur if you bowel is blocked patients. Some people have two with hard faeces or three bowel movements a day Headache and thirst whereas for others three or four movements per week might be What are the causes of more normal. constipation in myeloma patients? It is worth remembering that in the There are several reason why majority of people, the digestive you may have constipation as a system slows down with age, so as myeloma patient. It is important you get older, you may need to move to know what has caused your your bowels less often. constipation, as this will help both you and your doctor or nurse treat it What are the symptoms of effectively. constipation? Myeloma treatment and The symptoms of constipation supportive treatment include: Some treatments for myeloma can Fewer than three bowel cause constipation as they slow movements a week the moving of faeces through the Pain or discomfort when opening bowel. This causes more water to be your bowels removed from the faeces, resulting Passing small hard stools in dry, hard stools. Feeling bloated and tired Treatments and supportive Infoline: 0800 980 3332 5 treatments that may cause Dehydration constipation include: Your body needs a lot of fluid to help Thalidomide, lenalidomide move food through your intestines (Revlimid®) and bortezomib and also to keep your faeces soft. (Velcade®) If you are not drinking enough fluid Anti-sickness drugs (e.g. and you become dehydrated, your granisetron, ondansetron) faeces will become hard and you may have difficulty opening your Some chemotherapy drugs (e.g. bowels. vincristine) Most strong painkillers (e.g. Lack of exercise/poor mobility codeine, tramadol, oramorph®) If you are unable to exercise or it is hard for you to get around then Hypercalcaemia you may lose muscle tone in your Myeloma bone disease can increase stomach area and in your intestine. the amount of calcium in your blood As these muscles are needed which can cause hypercalcaemia. to help move food through the Symptoms of hypercalcaemia digestive tract, the decrease in include constipation and muscle tone can cause constipation. dehydration, as well as increased Prolonged sitting can also lead thirst and confusion. to constipation, as the effects of gravity can help to move food For more information see the Myeloma bone through your intestines. disease and bisphosphonates Infoguide from Myeloma UK Stress, anxiety and depression Periods of prolonged stress, Poor diet/loss of appetite anxiety or depression may cause If your diet is lacking in essential constipation. nutrients, particularly fibre, then you are more likely to become For more information see the Infopack for constipated. Fibre helps keep your living well with myeloma from Myeloma UK bowels healthy and active. It also helps keep your faeces soft and Change in routine increases the speed with which your food is digested.
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