Coping with Bowel Problems after Rectal Cancer

By Kate Murphy
Originally appeared in the March, 2012 issue of Quality Care®

Fred cannot play golf any more, although he has recovered completely from rectal cancer and has no sign it has come back, sudden urgent needs to use the bathroom keep him watching TV at home. He is afraid to be back on the golf course he loved so much before his radiation and surgery.

Martha doesn’t know how to explain the embarrassing accident she had at the pool to her grandchildren. Forced to wrap a towel around her suit and rush to the ladies room left her in tears.

Betsy wears a pad now to catch feces dribbling from her rectum and she worries about the odor. She’s told her friends that she can’t come to lunch with them anymore but is too shy to explain why.

Fred, Martha and Betsy are not alone. Some studies show more than half of people who have been treated for rectal cancer have some degree of fecal incontinence at least once a week.

After rectal cancer, bowel incontinence may be an urgent need to use the bathroom, constant diarrhea, not being able to feel that a bowel movement is on its way, stool leaking from the rectum  or accidental soiling. Some patients have many bowel movements a day, keeping them trapped at home near a toilet.

The Problem
Early rectal cancer is usually treated surgically. The operation, called total mesorectal excision, removes the cancer, part of the rectum and the fatty tissue and lymph nodes that surround it. Surgery can damage nerves or the sphincter muscle that keeps the rectum closed contributing to long-term bowel problems.

Some patients also get radiation, which improves chances that cancer will not return, but adds to long-term bowel difficulties.

When almost 600 people who had recovered from surgery or surgery and radiation for rectal cancer filled out a research questionnaire, half said they were dissatisfied with their bowel function.1

  • Even five years after treatment for their rectal cancer, as many as two out of three patients say they have some problems with fecal incontinence.
  • While some only have accidents once a week, some report problems every day.
  • Radiation definitely made things worse, with six out of ten people who had radiation in addition to surgery having incontinence at least weekly. But surgery is a problem too, say almost four out of ten.
  • Nearly six out of ten who had both radiation and surgery needed a pad to control accidental discharge.
  • One out of three who had radiation said that fecal incontinence had an impact on their daily activities at work and at home. Surgery without radiation kept one out of five from doing things every day that were important to them.

Some Solutions
Diet, Fiber and Water
Keeping a diary of what you eat and your bowel movements can help pinpoint  food that may make incontinence worse, but also help you find things to eat that make your bowel problems better.

Spicy and fatty foods can contribute to urgency. Coffee, alcohol and carbonated beverages trigger bowel activity. Foods that make a lot of gas like broccoli, cabbage or onions not only make incontinence worse. They can cause painful cramping.

Even if milk and ice cream didn’t bother you before your rectal cancer, intolerance to lactose (“milk sugar”) may cause diarrhea, gas and cramping afterwards. A simple first step to take is to remove all milk and milk products from your diet and see if things get better. Try lactose-free substitutes.

Foods with fiber that dissolves in water (soluble fiber) can reduce urgency and diarrhea. Examples of foods high in soluble fiber include sweet potatoes, carrots, apples and oat bran. Soluble fiber prevents the formation of intestinal polyps or inflammation by maintaining a healthy pH in the intestine, aids in the absorption of certain minerals and increases the production of helpful bacteria in the colon. While insoluble fiber absorbs water, resulting in bulkier, softer stool, soluble fiber ferments in the large intestine, producing fatty acids that significantly contribute to overall health. Both types of fiber are in most plant foods. Try adding more of these foods with high soluble fiber in particular to your diet.

Despite what you might think, drinking more water can actually slow down diarrhea. Water can mix with soluble fiber from food or fiber supplements to form a more solid stool.

Slowing Down Transit Time
When you eat, you prompt  your intestinal muscles to push food and waste rhythmically through your intestinal tract (peristalsis). If contents move too fast, you can end up with urgency and diarrhea.

Adding fiber to your diet will slow down the time it takes for food to move through your intestines.

Medications
If your problem is frequent diarrhea, loperamide (Imodium®) may help some people. Although loperamide is available over-the-counter, you should talk to your doctor about dosage and regimen before starting it.

Your doctor can also prescribe other medicines to slow transit time and reduce urgency.

Bowel Training
Sometimes you can teach your bowel to be more consistent. With training, you may be able to count on having a bowel movement at the same convenient time every day.

There are three steps to effective bowel training:

  1. Eat enough fiber and drink enough water so you have a large, soft stool. Your stool should be formed but not hard and difficult to pass.
  2. Find a good time for a daily bowel movement and stick to it. Many people find that about half an hour after breakfast is a good time. Eat a good breakfast that includes some whole grains. Some doctors recommend an ounce of prune juice before breakfast.
  3. Use a trigger to stimulate an intestinal push. A hot drink can be a good stimulant. If a cup of hot coffee or tea with breakfast isn’t working, talk to your doctor about a suppository.

Some rectal cancer patients have a smaller reserve and have to have several movements a day. They can train themselves to go to the bathroom right after each meal. The goal is no more than three stools a day.

Bottom Line
There is no need to be embarrassed if you have incontinence problems after radiation or surgery for rectal cancer. Although too few people talk about it, it is a very common issue.

But it is one you can do something about. Changing your diet, asking your doctor about medicines or starting a bowel training program can help.

Don’t keep it a secret.

1 Peeters et al., Late Side Effects of Short-Course Preoperative Radiotherapy Combined With Total Mesorectal Excision for Rectal Cancer: Increased Bowel Dysfunction in Irradiated Patients—A Dutch Colorectal Cancer Group Study, Journal of Clinical Oncology, September 1, 2005 vol. 23 no. 25 6199-6206

About The Author
Kate Murphy is a long-time colon cancer survivor. Due to inherited Lynch syndrome, she was diagnosed with colon cancer three times, as well as breast and ovarian cancer. She has an ostomy.

Currently she writes for Fight Colorectal Cancer, reporting regularly on new research findings. She develops patient information for the Fight Colorectal Cancer website.

An ardent advocate for better colorectal cancer research, Kate works with the National Cancer Institute developing and reviewing research proposals.

She knows colorectal cancer screening actually prevents colorectal cancer and can cut deaths from it in half. Kate urges everyone to be screened when they reach age 50.