From the Ovacome Magazine Spring 2019

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When facing chemotherapy or surgery for ovarian cancer, women will cite nausea, fatigue and losing their hair as main concerns. But there is another treatable but common side effect which should be on their radar, as dietitian Rachel White explains.

Altered bowel habits after surgery and during chemotherapy are very common. However, it is something which can usually be addressed with a change in diet, says Rachel White, an oncology dietitian at Guy’s Hospital.

“The main changes can be increased frequency of opening your bowels (diarrhoea) or decreased frequency (constipation). A normal bowel motion should be well formed, soft and easy to pass."

“Chemotherapy can affect your digestive system as it may damage the cells lining the tract. This is why you may see some changes in your bowels.

“Our digestive system is very sensitive and therefore any changes or movements internally may alter its function, this is exactly what happens during surgery. This can lead to changes in bowel habit after surgery, whilst our body recovers from the surgery."

“After surgery, pain relief medication, moving around less and reduced oral food intake can all cause constipation. Conversely diarrhoea can be brought on post surgery with different medication, such as antibiotics, or by taking too many laxatives."

“Wind and bloating can also be common, especially shortly after surgery when your bowels may not be working as well. This may settle once your bowels are opening regularly. Taking peppermint water may help to settle these symptoms, alternatively you can try walking around."

“It can take a few weeks to months for these symptoms to settle down.”

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What to do

“To settle your bowel - for constipation or diarrhoea - choose low fibre foods such as white bread and pasta, instead of wholemeal. Eat fewer leafy green vegetables, cook vegetables well and peel fruit. As your bowel improves, try to gradually reintroduce foods that caused you problems. You may find they no longer affect your bowel."

“If you continue to be limited in what you can eat, you may want to get advice from a dietitian."

“For diarrhoea, treatment such as anti-diarrhoeal medicine may help you to manage your bowel symptoms better, which may allow you to eat a wider range of foods."

“Drinking plenty water and exercise can be really helpful to keep your bowels moving if you are struggling with constipation. It doesn’t have to be a huge increase to make a difference. For example, if you are usually inactive, a regular daily walk can be sufficient to help stimulate the bowel to work regularly and strengthen your abdominal muscles.”

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Chemo action

“During chemotherapy, unless you are specifically told otherwise by your oncology team or dietitian, you should follow a healthy balanced diet as long as your weight is stable. Ensure that you are drinking adequate amounts of fluid – aim for two-litres (eight glasses) per day."

“Once chemotherapy has finished it may take a few weeks for any symptoms to settle down. As your symptoms improve then it will be important to ensure you are reintroducing any foods that you may have excluded back into your daily oral intake as long as your symptoms do not return. If you are struggling, then you may want to ask your oncology team to refer you to a dietitian.”

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After a blockage

“If you have experienced a bowel obstruction, the advice is to follow a low fibre diet once this has resolved. We encourage women to gradually start to incorporate fibre back into their diet as tolerated, and this will be based on the symptoms they are experiencing."

“Whilst someone is experiencing bowel obstruction, they will generally be nil by mouth (not able to eat or drink anything) to rest the bowel whilst they are waiting for it to resolve. This is decided by the oncology team. Sometimes surgery may be required to remove the part of the bowel where the blockage is, your doctors will liaise with the surgeons to see if this is possible."

“If you are experiencing bowel obstruction then you should be under the care of a dietitian, although whilst you are nil by mouth there may not be much input from your dietitian. However they can liaise with your doctors to ensure that your nutrition is considered during this time."

“Once your bowel obstruction resolves then it is important to build up your oral intake to ensure that you are not losing weight.”

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Returning to normal

“It is important to remember that everyone has slightly different bowel habits. It is normal to open your bowels from three times a day to three times a week. You are looking for changes that are different for you, rather than necessarily comparing against someone else."

“We would recommend following a healthy balanced diet, where possible to follow the Eatwell Guide. Ensure that you are getting plenty of fibre incorporated into your diet. The recommended amount of fibre is 30g per day. It is recommended that you gradually increase the amount of fibre to ensure that it doesn’t affect your bowels."

“Having a healthy bowel is important as it will enable you to absorb the nutrients in your food and improve your quality of life.”

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Useful websites/references

NHS website – Side effects of chemotherapy

Macmillan

British Dietetic Association (BDA): Food fact sheets

Cancer Research UK – a blocked bowel

Colostomy UK

Ovacome’s support line - 0800 008 7054

World Cancer Research Fund

The Eatwell Guide