Bowel changes after cancer treatment
Find out more about coping with bowel function after treatments for bowel cancer.
After cancer treatment your bowel function will usually settle into a more regular pattern after a few weeks or months. To begin with, you may have one or more of the following changes:
- needing to pass poo (stools) more frequently – this might be several times a day
- feeling that you cannot wait when you need to pass poo (urgency)
- feeling bloated or passing a lot of wind
- having a sore bottom
- not being able to have certain food and drinks without them affecting your bowel movements.
Any changes usually improve over time. Tell your surgeon or specialist nurse if you are having problems, or if your bowel movements are not settling into a more regular pattern. They can give you advice, prescribe medicines or refer you to a continence specialist nurse or dietitian.
After total mesorectal excision (TME), it could take several months for your bowel function to get into a more regular pattern. It may never be the same as it was before the cancer. In time, it should settle into more of a routine that will become normal for you. If you had radiotherapy or chemoradiation before or after rectal surgery, this will also affect your bowel. This could mean it takes longer to get back to having regular bowel movements.
After rectal surgery, as well as the changes listed above you may also have:
- loss of control of when you empty your bowels (incontinence)
- difficulty telling the difference between wind or stools
Tell your surgeon or specialist nurse if you are having problems.
Your doctor, dietitian or specialist nurse may advise you to follow a specific diet while your bowel recovers from surgery. They may give you different advice depending on:
- the type of surgery you had
- how much of your bowel has been removed
- whether you have a stoma (colostomy or ileostomy).
It is important to remember that your symptoms are probably caused by your surgery and not the foods you eat.
There are things you can do to help you cope with changes to your bowel function:
Eat at regular times to encourage regular bowel function.
If you have lost your appetite, it may be easier to eat several small meals a day, rather than one or two large meals.
Include high-protein foods such as fish, meat, eggs and diary products in your diet.
This will help your body to heal after surgery.
Follow a low-fibre diet for the first few days after surgery.
To allow your bowel to recover, you may be advised to choose low-fibre foods such as white bread, pasta, plain crackers and refined cereals.
Try to eat a healthy, well-balanced diet.
But some healthy foods may cause problems. Depending on the type of surgery you had, you may be advised to avoid some types of high-fibre foods. These include foods with pips, skins of fruit, undercooked and raw vegetables.
Keep a diary of what you eat and how it affects you
This can help you remember which foods are causing you problems. This means you are aware of what to avoid in your diet. As your bowel settles, try to gradually reintroduce foods that caused you problems. You may find they no longer affect your bowel.
Always check with your dietitian, doctor or specialist nurse if you are not sure what to do.
It may take time for your bowel function to settle. But there are things that can help you cope with bowel changes and feel more confident and in control. If your symptoms continue, always ask for help from your cancer doctor or specialist nurse.
If you have diarrhoea, you may be advised to add some fibre (roughage) to your diet. This can help to reduce diarrhoea, as it bulks up stools. Foods high in fibre include:
- wholemeal breads
- fruit and vegetables.
It is important to drink at least 2 litres of fluid a day, especially if you have loose stools or diarrhoea, or constipation. Fluids can include:
- hot drinks.
You may have a lot of diarrhoea or pass a lot from your stoma. If this happens, have less fluid at mealtimes.
Your cancer doctor or specialist nurse may recommend you take anti-diarrhoea drugs. The most commonly used drug is loperamide (also called Imodium® or Diareze®). It slows down your bowel movements, making the stools more solid and less frequent.
Taking loperamide regularly, half an hour before meals, works well for some people. Loperamide is also available as a syrup, so you can change the dose as needed. It may take time to find the dose that works best for you. Your cancer doctor may recommend you start with a low dose and increase this until it works.
It is safe to take loperamide for as long as you need it, but you should discuss this with your cancer doctor. Your dietitian can explain changes you could make to your diet to help manage diarrhoea.
You may have problems with excess wind or bloating after bowel surgery. Here are some tips:
- Try to avoid food and drink that can cause wind – these include beans, garlic, onions, sugar-free chewing gum, fizzy drinks and some alcoholic drinks.
- Eat slowly and chew food well.
- Taking peppermint capsules or drinking peppermint water diluted with some warm water might help. You can get these from your local pharmacy.
- Drinking peppermint or fennel tea may also help.
Constipation can sometimes be a problem after surgery to your bowel. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular, gentle exercise, like going for short walks.
If you have constipation, contact your GP or hospital for advice. Your doctor can give you drugs called laxatives to help.
Ask your dietitian about what changes you can make to your diet. If you have a stoma, your stoma nurse will give you advice about this.
We have information about eating problems and cancer that explains common eating difficulties and offers practical tips for managing them.
Protect your skin
- Keep the skin around your back passage clean and dry. Whenever possible, wash the area after a bowel movement.
- Use unperfumed wet wipes, as they are softer on your skin than toilet paper. Pat the area gently when drying.
- You may find wiping with damp cotton wool softer on your skin.
- Use absorbent pads and barrier creams (such as Cavilon®, Sudocrem® or Bepanthen) to help protect your skin. A colorectal or continence nurse can tell you the best pads and cream to use.
- Wear cotton underwear, which allows your skin to breathe. Avoid tight jeans or other clothes that may rub the area.
If your bowel habit isn’t predictable, you may feel worried about going out, especially to somewhere new. Planning ahead so that you are prepared can help you feel more confident.
Carrying a Just Can’t Wait card may help you to get access to a toilet more quickly when you are out. It states that the card holder has a medical condition that requires urgent access to a toilet. You can get a card from the Bladder and Bowel Community.
You can use disabled toilets too. These often offer more privacy, have a wash basin and more space if you need to change.
The National Key Scheme offers people with a disability access to about 9,000 locked public toilets across the UK. You can buy a key from Disability Rights UK. They can also send you details of where the toilets are.
Macmillan also has a toilet card for people who have problems with bowel or bladder control. It gives you urgent access to a toilet when out in public. You can get one by phoning our support line on 0808 808 00 00 or you can order one at be.macmillan.org.uk.
Carry a bag with supplies
Pack a bag with things you may need when you go out. This will make you feel more confident and help you to cope if an accident happens.
You may want to include:
- wet wipes
- barrier cream, such as Cavilon® or Sudocrem®
- loperamide (anti-diarrhoea tablets), if you have bowel control problems
- pads and spare underwear
- stoma supplies if you have a stoma
- a change of clothing
- a sealable bag.
Your emotions can affect your bowel. Anxiety and stressful situations can make poo looser and more frequent. If you don’t feel in control of your bowel, this in itself can be stressful.
Learning how to relax may help your bowel to settle and is good for your general health. Your doctor or specialist nurse can tell you about relaxation classes in your area. Some support groups also offer relaxation classes.
Pelvic floor exercises
There are exercises you can do to strengthen the muscles used for bowel control. There are two main groups of muscles that are important for bowel control:
- the sphincter muscles in the back passage (anus)
- the pelvic floor muscles.
Pelvic floor muscles are also important for bladder control and sexual function.
Pelvic floor exercises may help if you have problems with leakage of wind or stool from your back passage. A colorectal or continence specialist can tell you if these exercises are likely to help you. They can teach you how to do them.
It can take at least 12 weeks of doing pelvic floor exercises, three times a day, to rebuild strength in these muscles. As your muscles improve, try doing the exercises while doing everyday jobs.
We have more information about pelvic floor exercises after treatment.
Where to get help and support
As well as the support available from Macmillan, there are other organisations and support groups that can offer you practical and emotional support.
IA – Ileostomy and Internal Pouch Association
Bowel Cancer UK
Below is a sample of the sources used in our bowel cancer information. If you would like more information about the sources we use, please contact us at email@example.com
R Glynne-Jones, PJ Nilson, C Aschele et al. ESMO-ESSO-ESTRO Clinical practice guidelines for diagnosis, treatment and follow up for anal cancer. July 2014. European Society of Medical Oncology. Available from www.esmo.org/Guidelines/Gastrointestinal-Cancers/Anal-Cancer (accessed October 2019).
National Institute for Health and Excellence (NICE). Colorectal cancer: diagnosis and management clinical guidelines. Updated December 2014. Available from www.nice.org.uk/guidance/cg131 (accessed October 2019).
Association of Coloproctology of Great Britain & Ireland (ACPGBI). Volume 19. Issue S1. Guidelines for the management of cancer of the colon, rectum and anus. 2017. Available from www.onlinelibrary.wiley.com/toc/14631318/19/S1 (accessed October 2019).
BMJ. Best practice colorectal cancer. Updated 2018. Available from www.bestpractice.bmj.com/topics/en-gb/258 (accessed October 2019).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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