Diarrhea

This information explains what diarrhea (dy-uh-REE-uh) is and how to manage it.

About Diarrhea

Diarrhea is a loose or watery bowel movement (poop), having more bowel movements than what’s normal for you, or both. Here are other common symptoms of diarrhea. You may have none, some, or all of these:

• Abdominal (belly) pain and cramps.
• Gas.
• Mucus in your bowel movement. Mucus is a jelly-like substance. It coats the inside of your colon (large intestine).
• Bleeding from your rectum. Your rectum is the last part of your colon. It holds your bowel movements before they leave your body.
• A fever of 100.4 °F (38 °C) or higher.
• Dehydration, which is not having enough water in your body. Symptoms of dehydration include:
  • Increased thirst.
  • Dry mouth and skin.
  • Lower urine output (when the amount you pee is less than usual).
  • Dark, amber-colored urine (pee).
  • Fatigue (feeling more tired and weak than usual).
  • Muscle, abdominal, or leg cramps.
  • Feeling dizzy or lightheaded (like you’re going to faint).

Many people get diarrhea at some point during their cancer treatment. If you have diarrhea, talk with your healthcare provider. They will help you find the best way to manage it.

Some infections that cause diarrhea can spread from person to person. The best way to prevent these infections is to wash your hands with soap and water. Wet your hands with warm water and apply soap. Rub your hands together for at least 20 seconds, then rinse. Make sure to wash your hands this way after using the bathroom and before eating.

Managing Diarrhea

Ask your healthcare provider about the best way to treat your diarrhea. They may have suggestions that are just for you. These suggestions may be different than the guidelines in this section. Managing diarrhea is different for everyone, including how long it takes to feel better.

Medication To Treat Diarrhea

Do not take any medication to treat diarrhea without talking with your healthcare provider first. Depending on the reason you’re having diarrhea, taking medications to stop it may be harmful.

If it’s safe for you, your healthcare provider may prescribe a medication or an antibiotic to treat your diarrhea. An antibiotic is a medication that kills bacteria and other germs. They may also suggest an over-the-counter medication you can buy at your local pharmacy without a prescription.

Diet Guidelines To Manage Diarrhea

Follow these diet guidelines to help manage your diarrhea and ease your symptoms.

Eat Small Meals

Try to eat 6 or more “mini” meals each day when you have diarrhea. Smaller meals are easier to digest than a big meal.

Follow the BRATT Diet To Help With Acute Diarrhea

The BRATT diet is a bland food diet. BRATT stands for:

• Banana
• Rice
• Applesauce
• Tea (decaffeinated)
• Toast

The goal of the BRATT diet is to ease acute (short-term) diarrhea. Acute diarrhea usually lasts 1 or 2 days and goes away on its own. Do not follow the BRATT diet if you have persistent or chronic diarrhea (diarrhea that lasts longer than 2 weeks).

The BRATT diet is low in fiber, fat, caffeine, and lactose (a sugar found in milk and other dairy products). Choosing low-fiber foods limits how much undigested food moves through your digestive tract (stomach and intestines). This means your body will make less poop. The poop that your body does make will move through your digestive tract more slowly and be more solid.

Because the BRATT diet limits what you can eat and drink, you will not get all the nutrients you need. This means you should only stay on the diet for a short time. Stop the diet within 1 to 2 days after having acute diarrhea. As you start to feel better, slowly add more foods and liquids back into your diet.

For more information about the BRATT diet, read BRATT Diet Phase 1 (www.mskcc.org/cancer-care/patient-education/bratt-diet-phase-1) and BRATT Diet Phase 2 (www.mskcc.org/cancer-care/patient-education/bratt-diet-phase-2).

Slowly Add More Foods and Liquids Back Into Your Diet

Once you stop the BRATT diet, slowly add the following foods and liquids back into your diet. They’re easy to digest and will give you enough nutrients.

You can also follow these diet guidelines if you have persistent or chronic (long-term) diarrhea. Persistent diarrhea is diarrhea that lasts between 2 and 4 weeks. Chronic diarrhea is diarrhea that lasts longer than 4 weeks (1 month).

Meat and Meat Substitutes

• White-meat poultry with the skin removed, such as chicken and turkey
• Plain baked fish
• Eggs
• Tofu
• Nut butters, such as smooth, creamy peanut, almond, and cashew butters

Vegetables

Eat 1 serving of vegetables every day, as tolerated. Half a cup of cooked vegetables is 1 serving.

• Well-cooked (fork-tender) vegetables, such as carrots, green beans, asparagus tips, and beets
• Baked or boiled potatoes with the skin removed

Fruits

Eat 1 serving of fruit every day, as tolerated. One small piece of fruit or ¾ cup of fruit cocktail is 1 serving.

• Bananas and melons, such as watermelon, cantaloupes, and honey dew
• Cooked or canned fruits with the skin and seeds removed, such as applesauce, peaches, pears, and fruit cocktail in juice

Breads and Grains

• White bread, rolls, plain bagels, and English muffins
• Saltine crackers
• Pretzels
• Graham crackers
• Cold cereals, such as cornflakes, Corn Chex^™, puffed rice, Rice Chex^™, and Rice Krispies^®
• Hot cereals, such as Cream of Rice^®, Cream of Wheat^®, and Farina^®
• White rice
• Pasta made from refined flour, such as white, enriched, and semolina flour

Dairy

Lactose is a natural sugar that’s found in milk and other dairy products. When your bowels (intestines) are irritated, you may not be able to fully digest or break down lactose. This can cause gas, stomach cramping, and diarrhea. Choosing these products that are lower in lactose or lactose-free may help:

• Lactose-free milk, such as Lactaid^® and Dairy Ease^®
• Lactose-free cottage cheese
• Lactose-free ice cream
• Lactose-free yogurt, Greek yogurt, or plain yogurt with probiotics (live active cultures)
• Kefir (many are 99% lactose-free)
• Hard cheeses, such as Swiss and cheddar
  • Low-fat, block, hard, and aged cheeses are usually lower in lactose.

Plant-Based Drinks

• Fortified non-dairy milks, such as almond, cashew, coconut, and rice milks
  • These milks usually are not good sources of protein. To get enough protein in your diet, you will need to eat other protein-rich foods. For examples of protein-rich foods, see the “Meat and Meat Substitutes” list above.
• Fortified pea milk and soy milk
  • These milks may cause gas and bloating in some people.

Foods and Liquids To Avoid

High-Fiber Foods

Fiber is the part of your food that your body does not digest. It’s what most of your bowel movements are made up of. Don’t eat high-fiber foods when you have diarrhea. These include:

• Whole grains, such as barley or quinoa, and whole grain breads and cereals, such as bran
• Cooked or raw gas-producing vegetables, such as onions, garlic, cabbage, cauliflower, broccoli, and Brussels sprouts
• Fresh fruit with skin, such as apples and grapes
• Beans, peas, corn, and popcorn

High-Fat Foods

Eating high-fat foods can make your diarrhea worse.

Try to limit the following:

• Butter
• Margarine
• Oil
• Salad dressing

Don’t eat:

• Fried foods
• Gravies
• Cream sauces
• High-fat deli meats, such as bologna, salami, and liverwurst
• Sausage and bacon

Foods and Liquids With Lactose

Try to avoid foods and liquids with lactose when you have diarrhea. These include:

• Milk (low-fat, whole, and skim)
• Soft cheeses, such as cream cheese, feta, and brie
• Cream and sour cream
• Ice cream and sherbet

If you cannot avoid foods and liquids with lactose, you can take a lactase supplement, such as Lactaid. A lactase supplement helps you digest lactose. Take the supplement before you eat or drink any milk or dairy products.

High-Sugar Foods and Liquids

Avoid high-sugar foods and liquids when you have diarrhea. They can be hard to digest and may make your diarrhea worse.

• Foods and liquids that have sorbitol, xylitol, mannitol, and other sugar alcohols. Sugar alcohols are found in some gum and sugar-free hard candies.
• Sugary drinks, such as fruit juice, soda, and energy drinks. Sugar can make your poop watery, which can make your diarrhea worse.

Liquid Nutritional Supplements

Avoid drinking liquid nutritional supplements when you have diarrhea. They’re low in lactose but may cause diarrhea because they’re high in sugar and fat. These include:

• Ensure^® Plus
• Boost Plus^®

If you cannot avoid drinking liquid nutritional supplements, the following things can help keep your diarrhea from getting worse:

• Drink your nutritional supplement in small amounts. Drink only ⅓ cup (80 ml) to ½ cup (120 ml) at a time.
• Dilute (mix) your nutritional supplement with water. Mix ½ cup (120 ml) of your nutritional supplement with ½ cup (120 ml) of water.
• Try a nutritional supplement that’s lower in fat and sugar, such as Ensure High Protein or Ensure Original. It may be easier to digest.
• Try a clear version of your nutritional supplement, such as Isopure^® Zero Carb or Ensure Clear. If you’re drinking Ensure Clear, mix ½ cup (120 ml) of it with ½ cup (120 ml) of water.

If you’re on a special diet or have diabetes, it may be hard for you to follow these guidelines. A clinical dietitian nutritionist or a diabetes educator can work with you. Ask your healthcare provider for a referral. A referral is when your healthcare provider sends you to see another healthcare provider for more services.

Preventing Dehydration

You’re more likely to become dehydrated when you have diarrhea. This is because diarrhea causes you to lose more fluid from your body than usual. The following things can help prevent dehydration.

• Try to drink at least 8 to 10 (8-ounce) glasses of liquids each day. This will help you replace the fluid your body loses from having diarrhea. This process is called rehydration, and is the most important treatment for diarrhea.
• Drink small amounts of liquids often. This is more helpful than drinking large amounts of liquids at once.
• If you don’t enjoy drinking water, try adding a few drops of fruit juice to add flavor.
• Drink hydration fluids, such as Pedialyte^® and Rehydralyte^™. These fluids have electrolytes, which help balance the fluids in your body and keep you from becoming dehydrated.
• Drink clear soups, broth, gelatin (such as Jell-O^®), and Gatorade^®. These liquids have salt and sugar, which can help keep you from becoming dehydrated and feeling weak.
• Don’t drink alcohol or liquids with caffeine, such as coffee, tea, and some sodas. They can make you dehydrated.

Caring for the Skin Around Your Anus

Diarrhea may irritate the area around your anus (the opening where poop leaves your body). It can cause itching, pain, or a rash and make hemorrhoids (swollen veins in your anus) worse. The following things can help prevent irritation. Talk with your healthcare provider about which options are safe for you.

• Use witch hazel pads (such as TUCKS^® Medicated Cooling Pads) to help lessen pain and swelling. Hold the pads against the skin around your anus. You can keep the pads in your refrigerator so they’re cool, or you can use them at room temperature. You can buy witch hazel pads at your local pharmacy without a prescription.
• Use a pain relief cream that does not have steroids, such as a hemorrhoid cream with pramoxine. An example of this is Preparation H^® Maximum Strength Pain Relief Cream. Put the cream on the skin around your anus up to 4 times a day. Put it on either before or after you have a bowel movement, whichever is more helpful. You can buy pain relief creams at your local pharmacy without a prescription.
• Use a vitamin A&D cream (such as A+D^® ointment) or a zinc oxide cream (such as Desitin^® cream). Put the cream on the skin around your anus after every bowel movement. Put it on right after you dry the area to prevent rashes and soothe your skin. Do not put on any of these creams if you have already put on a pain relief cream. You can buy vitamin A&D and zinc oxide creams at your local pharmacy without a prescription.
• Take a sitz bath after every bowel movement or as needed. A sitz bath is a warm, shallow bath that cleanses your anus. You can buy a plastic sitz bath that fits over your toilet at your local pharmacy without a prescription.
• If you cannot use a sitz bath, use unscented baby wipes to cleanse your anus. Gently wipe the skin around your anus with the baby wipes after every bowel movement. Dry the area with a soft towel. Don’t use scented baby wipes. They can irritate your skin. You can buy unscented baby wipes at your local pharmacy without a prescription.
• Wear loose underwear and pants. Don’t wear thong underwear.
• Avoid any activities that may hurt the area around your anus, such as riding a bicycle, motorcycle, or horse.
• Don’t use scented body lotion on the skin around your anus. It can irritate your skin.

Once you finish taking care of the skin around your anus, wash your hands with soap and water. Wet your hands with warm water and apply soap. Rub your hands together for at least 20 seconds, then rinse. This is the best way to prevent infections that cause diarrhea from spreading person to person.

When To Call Your Healthcare Provider

Call your healthcare provider if:

• Your diarrhea does not get better after you follow the guidelines in this resource.
• You have diarrhea with bright red blood in it.
• You have dark-colored poop with bloody streaks in it.
• You have a fever of 100.4 °F (38 °C) or higher.
• Your abdomen is painful or swollen and does not feel better after you take medication.
• You have fatigue.
• You cannot drink liquids without vomiting (throwing up).
• You’re vomiting.