Diarrhoea refers to the increased frequency and decreased consistency of bowel motions. Certain chemotherapy drugs are more likely to cause diarrhoea than others. Symptoms can range from mild to severe and generally last for several days after treatment.

There are a number of disease and treatment related factors which can cause diarrhoea. They include:

• chemotherapy drugs, particularly irinotecan, fluorouracil and capecitabine
• stem cell transplantation, as this includes high dose chemotherapy +/- total body irradiation
• graft versus host disease (occurs following stem cell transplantation)
• radiation therapy to the pelvis and/or abdomen
• patients aged over 65 years
• psychosocial issues, including stress/anxiety
• previous history of other conditions which cause diarrhoea (i.e. chronic intestinal dysmotility (CID), Crohn’s disease, irritable bowel syndrome)

Your health professionals will discuss whether you are at risk of diarrhoea. There are strategies which can help prevent diarrhoea:

• ensure you drink enough water and other beverages (avoid dairy-based fluids and drink clear fluids instead)
• report signs of dehydration, including:
  • low urine output
  • rapid heart rate
  • headache/dizziness
• modify your diet to prevent exacerbation of symptoms. Consider talking to a dietitian who can support you to manage your diet
  • avoid fatty/greasy and spicy foods, and raw vegetables and fruit
  • consume small, frequent, bland, low fibre meals (e.g. bananas, rice, noodles, white bread, skinless chicken or white fish)
  • avoid caffeinated beverages and alcohol
  • limit dairy products
• ensure peri-anal area is kept clean by regularly washing with tepid water and mild soap
• apply barrier cream if your skin becomes irritated

Your doctor may prescribe medication to help you manage your symptoms. Although this medication is also available without prescription, it’s important that you discuss your situation with your care team. Your treatment regime may need to be adjusted depending on your symptoms.

You should record the frequency of bowel movements and seek medical attention if symptoms worsen or you experience:

• a temperature above 38°C
• motions that are black or have fresh blood present
• dark concentrated urine
• stomach cramping or pain
• diarrhoea that does not resolve in 24 hours, or becomes severe and very frequent (more than five episodes within 24 hours)