Bowel problems

How might lymphoma affect my bowel?

Bowel problems such as diarrhoea, constipation and wind (flatulence) can happen with lymphoma and its treatment for a number of reasons, including:

• the effects of the lymphoma itself
• side effects of treatment such as chemotherapy, radiotherapy to the tummy (abdominal) area, targeted therapies, anti-sickness medicines (antiemetics) and painkillers
• heightened stress and anxiety, which could both cause and worsen bowel problems
• infection, usually of the digestive system (gastrointestinal tract).

Bowel problems are quite a common side effect of lymphoma treatment, and your medical team are there to help you manage them. I had constipation that started almost immediately after treatment and lasted for about a week. My nurse recommended a medicine that really helped.

Stephen, diagnosed with Hodgkin lymphoma

Back to top

Diarrhoea

Diarrhoea can be caused by lymphomas that affect the gut, such as:

• MALT lymphoma 
• mantle cell lymphoma 
• intestinal T-cell lymphomas (for example enteropathy-associated T-cell lymphoma (EATL))

It can also be caused by lymphoma treatments that damage the gut lining, such as some chemotherapy drugs and some targeted therapies.

When does diarrhoea start after treatment?

Diarrhoea can start within a few hours to a few days after having lymphoma treatment. If your diarrhoea is not due to infection, your medical team can prescribe medication. This can lower the risk of it happening with your next round of treatment.

How long does diarrhoea go on for?

If you have diarrhoea caused by lymphoma or its treatment, it’s usually mild. For most people, it gets better once you finish treatment – often within a few days. 

Why should I talk to my medical team if I have diarrhoea?

Speak to your medical team if you have diarrhoea, so that they can offer advice. Be aware of when to talk to them urgently – often, doctors advise you to do so if you have frequent and ongoing diarrhoea. 

If necessary, your doctors can prescribe medication to help ease diarrhoea. In some cases, they might also adjust your lymphoma treatment. This could help to prevent you from getting diarrhoea as a side effect of treatment in the future.

There are also some self-care things you can do help cope with diarrhoea.

When should I contact my medical team urgently about diarrhoea?

There are times that you should contact your medical team as a matter of urgency. 

Get medical advice straightaway if you:

• are having treatment for lymphoma and your diarrhoea goes on longer than 3 days 
• are not on active treatment for lymphoma and your diarrhoea goes on longer than 2 weeks
• notice blood in your poo
• your poo is very dark brown or black and it is not normally this colour – note that if you take iron supplements, your poo might already be darker or black and this is not a medical concern
• have a lot of painless watery diarrhoea
• have diarrhoea that wakes you up
• have ongoing or severe stomach cramps
• feel sick or have persistent vomiting (being sick) twice or more a day
• are losing weight without trying to
• can’t eat or drink without having diarrhoea afterwards 
• are becoming more and more tired or weak
• have a fever (temperature above 38°C/100°F).
• are dehydrated – signs of dehydration include: thirst, dark-coloured wee, weeing less often than is usual for you, feeling light-headed or dizzy, dry mouth, lips or tongue, sunken eyes.

You should also tell any medical professionals looking after you if you are taking, or have recently taken, antibiotics – it’s possible that these are the cause of your diarrhoea.

What problems can diarrhoea cause?

Diarrhoea doesn’t usually last for long. However, the loss of fluid can cause dehydration and an imbalance of electrolytes (chemicals in your body), leading to symptoms such as muscle weakness, extreme tiredness (fatigue) and dizziness. Talk to your medical team if you experience such symptoms.

Diarrhoea can also affect your day-to-day life. For example, you might feel embarrassed about it, or anxious about leaving your home because of it. We give some tips below.

Back to top

Tips to help you cope with diarrhoea

There are some things you can do that might help if you have diarrhoea. Your medical team might also recommend a medicine to help treat diarrhoea.

We give some tips about:

• eating and drinking
• things to help you feel comfortable in your day-to-day life, including things to think about if you are out and about. 

Remember that having diarrhoea uses up a lot of energy. Take rest and think about any tasks you can ask other people to help you with.  

Eating and drinking if you have diarrhoea

You might not want to eat very much if you have diarrhoea. Doctors usually recommend that you eat as soon as you feel able to.

You might find it easier to eat little and often throughout the day, until you can go back to your usual eating patterns. 

You could also make some short-term changes to your diet to help improve your symptoms. Below is some general guidance about foods and drinks to choose and to avoid. You can find out more about the different types of food, including examples, on the NHS website.

Foods to choose

Foods that might help to improve diarrhoea include:

• low-fibre foods, which includes white bread, white rice, pasta and noodles 
• foods that are high in potassium, such as bananas, broccoli, nuts, seeds and fish. 

Foods to avoid

Foods that might make diarrhoea worse include:

• spicy foods
• foods that are high in fat or sugar
• foods that have a lot of artificial sweeteners in them
• citrus fruits 
• onions
• some diary products, such as icecream and whipped cream.

If someone is experiencing diarrhoea, I would tend to suggest avoiding foods that are high in sorbitol – this is found naturally in fruits and vegetables like prunes, kiwis and spinach. It can also help to lower your intake of fibre for a while, so avoid grains and oatmeal, for example.

Chrissie Kirby, Haematology Clinical Nurse Specialist  

Drinks to choose

Drink at least 2 to 3 litres (3.5 to 5.5 pints) each day to help replace lost fluids. Sip these a bit at a time throughout the day. 

Drinks to choose include:

• plain water
• weak (diluted) squash
• herbal tea
• clear soups of broths
• coconut water
• oral rehydration solutions.

Drinks to avoid

Some drinks can make diarrhoea worse, including:

• fruit juice
• caffeinated drinks like tea and coffee
• fizzy (carbonated) drinks, particularly those that are caffeinated
• alcohol
• dairy milk.

Feeling comfortable in your day-to-day life if have diarrhoea

We give some tips below about:

• clothes to wear 
• soothing sore skin around your bottom (back passage)
• feeling comfortable in bed
• things to think about if you are out and about.

Clothes to wear

• Wear clothes on your bottom half that are easy to take down or take off if you need to go to the toilet urgently. Avoid fiddly zips, buttons or other fastenings.
• Have a spare pair of clothes for your bottom half ready so that you can change if and when you need to. 
• Wear loose-fitting, cotton underwear to help reduce skin irritation if the area around your bottom (back passage) is sore.

Soothing sore skin

• Have a warm bath.
• Wash your bottom with a mild, fragrance-free soap and water. 
• Pat the area with a soft towel to dry it after washing.
• Wipe your bottom clean with baby oil instead of toilet tissue.
• Ask your medical team if they can recommend a soothing cream.

Feeling comfortable in bed

• Protect your mattress with a protector or plastic sheet.
• Wear a disposable waterproof (incontinence) pad.
• If your diarrhoea is severe, you could talk to your medical team about the possibility of a having a commode (a chair with a hidden toilet pan inside) by your bed.

Things to think about when you’re out and about

• Plan your journey and find out before you go where toilets are before you go. You could use The Great British Public Toilet map to help you. 
• Consider having a toilet card.
• Take toiletries such as a body spray with you.
• Carry spare clothes and a plastic bag in case of soiled clothes.
• Protect your underwear with a disposable waterproof (incontinence) pad – you can buy these in a pharmacy, chemist, supermarket or online. Your hospital might also be able to give you some.

Toilet cards

You could carry a physical or digital card that allows you to communicate quickly with other people that you have a medical condition and need to use the toilet urgently. For example:

• Age UK also produce a Vivactive Toilet Card.
• The Bladder and Bowel Community produce a Just can’t wait toilet card.
• Macmillan Cancer Support produce a Toilet card.

Back to top

What treatment is there for diarrhoea?

Ask your medical team about any treatments they could offer you (antidiarrhoeal medicines). 

It’s important not to take over-the-counter medicines without speaking to a healthcare professional for advice specific to you. Some might not be helpful or suitable for you. For example, if you are having lymphoma treatment, have any other health conditions, you’re pregnant or you’re taking other medicines. Your doctor can tell you about any options available to you and give advice about how much to take, when and for how long. 

Oral rehydration solutions

Oral rehydration solutions (ORS) help replace sugars and salts lost with diarrhoea. They come as sachets of powder that dissolve in water to drink. Your medical team might suggest these as well as other antidiarrhoeal medicines. You can then then buy these over-the-counter, without a prescription. 

Antidiarrhoeal medicines

You might be given a medicine to treat diarrhoea (antidiarrhoeal medicine). Some are available to buy over-the-counter. 

Loperamide is a common antidiarrhoeal medicine used to treat diarrhoea related to cancer. Loperamide comes in capsules, tablets, liquid medicine and ‘melts’ (tablets that dissolve in your mouth). You can find out more about loperamide on the NHS website.

Speaking to a healthcare professional before you take an over-the-counter medicines

It’s important to speak to a relevant healthcare professional before taking an over-the-counter medicine. 

• If you are having lymphoma treatment, ask your hospital consultant haematologist or oncologist for advice. 
• If you are not on active treatment, ask your GP, pharmacist or NHS 111 for advice.

Hospital treatment

Blood tests and your symptoms can help doctors tell if you are severely dehydrated. If this is the case, you might need hospital treatment, such as:

• fluids through a drip into a vein (intravenously or by ‘IV’)
• an injection with octreotide – a drug that increases the absorption of fluids in the gut and reduces muscle movements of the small intestine (part of the digestive system).

Back to top

Constipation

As well as finding it difficult to poo, other possible symptoms of constipation include:

• going to the toilet less than is usual for you
• straining to go to the toilet, which can lead to bleeding from your bottom
• feeling as though you’ve not completely emptied your bowels after you’ve been to the toilet 
• small, dry hard or lumpy poo
• feeling bloated
• feeling or being sick
• having a hard, sore or tender tummy
• loss of appetite
• stomach cramps.

Constipation can be a side effect of:

• some chemotherapy and targeted drugs
• radiotherapy to the pelvis or digestive (gastrointestinal) tract 
• some painkillers, particularly opioids such as codeine and morphine
• some anti-sickness (antiemetic) drugs, such as ondansetron.

Having a combination of these treatments can worsen constipation. Constipation can also be worse if you are already constipated before starting treatment. Tell your medical team if this is the case – they might prescribe some laxatives before you start treatment.

I found that, by far, the worst treatment side effect for me was constipation. But you learn, in my case with the help of my wonderful GP, how to control them.

Paul, diagnosed with high-grade non-Hodgkin lymphoma

Tell a member of your medical team if you are constipated. Depending on the cause, they might offer you a laxative medicine to help you go to the toilet.

There are also some steps you can take to help you cope with constipation. 

When does constipation start after treatment?

Constipation can vary depending on the treatment type and the individual person.  For many people, it can happen within 3 to 5 days of having treatment. Ask your medical team for information specific to your situation. 

How long does constipation go on for?

Although constipation can happen throughout treatment, it can often be well-managed. For a lot of people, it is better by the end of treatment.  

Constipation can happen throughout treatment, but it is usually manageable, especially if you seek medical advice in a timely manner from your medical team.

Chrissie Kirby, Haematology Clinical Nurse Specialist  

Why should I talk to my medical team about constipation?

Talk to your medical team so that they can offer advice to help ease constipation. Be aware of when to talk to them urgently.

When should I contact my medical team urgently about constipation?

Ask for medical attention urgently if you have severe constipation – possible symptoms include:

• blood in your poo
• severe tummy pain
• incontinence 
• feeling sick or being sick
• stomach cramps
• a feeling of fullness.

These can be a sign that need you need urgent treatment. It is therefore important that you seek medical advice. You will need to be examined and treated accordingly. For example, you might be given suppositories (a type of laxative) or an enema. In some cases, a different procedure of manual extraction treatment might be used – however, this is not a common treatment.

In most cases, we want to know if someone hasn’t opened their bowels within 2 to 3 days. Also, if the lymphoma is in the bowel area, it’s important to let your medical team know urgently if you become constipated, in case there is a blockage in your bowel. You can ask your medical team if you’re unsure if lymphoma is in your bowel area.

Chrissie Kirby, Haematology Clinical Nurse Specialist  

What should I do if I have constipation?

Speak to your medical team if you have constipation, so that they can offer advice. If necessary, they can prescribe medication. They can also include laxatives within your treatment plan to lower the risk of it happening with future rounds of treatment.

There are also some self-care things you can do help cope with constipation.

What problems can constipation cause?

Constipation can be uncomfortable and make your tummy feel sore and bloated. 

If you can’t go to the toilet for a few days, your doctor might consider treatment approaches to help. 

Back to top

Tips to help you cope with constipation

Making some changes in your day-to-day life can help to ease constipation. We give some general tips below about diet and nutrition, and lifestyle. The NHS website also has a video about how to treat constipation with diet and lifestyle factors. However, speak to your medical team for advice specific to your situation if you are concerned.

Diet and nutrition

Some food and drinks can act as natural laxatives to help prevent or ease constipation.

• Eat a healthy, balanced diet with plenty of high-fibre foods, such as wholegrain cereals, porridge oats, wholemeal bread, brown rice, wholemeal pasta, potatoes with their skins left on, fruits, vegetables, beans, lentils and pulses.
• Eat around the same times each day to help with regular bowel movements.
• Drink at least 2 litres (3.5 pints) of fluids each day. Caffeinated and carbonated (fizzy) drinks can worsen constipation so are best avoided.
• Eat foods that are high in sorbitol (a type of natural sugar that can help to soften poo and make it easier to pass). Example are apples, apricots, blackberries, grapes, peaches, pears, plums, prunes, raisins, raspberries and strawberries.

Lifestyle

Certain lifestyle habits can be helpful in encouraging regular bowel movements.

• Do some light physical activity each day – even a gentle walk or stretching can help.
• Go the toilet as soon as you can when you need to – waiting can make constipation worse.
• Try to go for a poo at a regular time each day – for example, in the morning or half an hour after meals.
• Give yourself enough time and privacy to go to the toilet. Hurrying, or feeling as though you do not have privacy, can worsen constipation.
• Try keeping your knees above your hips when you go for a poo – it might help to rest your feet on a low footstool.
• Manage stress and anxiety – these can make constipation worse.

Back to top

What treatment is there for constipation?

In general, treatment isn’t needed for constipation. Constipation can improve with diet and lifestyle changes. However, your doctor might prescribe a laxative to help ease symptoms. 

Laxatives are medicines to help you poo more regularly. Some are available to buy without a prescription, including herbal remedies. However, it’s important to seek medical advice before you take one. This is because not all laxatives are suitable or effective in all situations –for example, if you are taking another medication or have low blood counts. 

There are different types of laxatives that work in different ways. They also come in different forms:

• oral: tablets, capsules, liquids, ‘melts’ (tablets that dissolve in your mouth) or powders that dissolve in water for you to drink
• suppositories, that you place into your bottom (back passage), where they dissolve.

As with any medication, if you’re prescribed laxatives, take them according to your doctor’s advice. Do not stop taking them suddenly, even if your symptoms ease.

Other approaches to help treat constipation could include:

• adjustments to your lymphoma treatment or other medications
• suppositories
• trying other types of laxatives
•  enema – where liquid is put into your bottom to soften your poo and to help empty your bowel
• manual extraction – where a health professional uses their fingers to check for a blockage of poo and to clear it; however, this isn’t a common approach for people with lymphoma.

Not all options are suitable for everyone. Your doctor will choose the best option for you.

Back to top

Flatulence (wind)

Some lymphoma treatments can cause gas to build up in your digestive system leading to increased wind.

Wind isn’t a serious medical problem. Usually, it doesn’t need treatment. However, it can be uncomfortable and embarrassing. There are things you can try to help manage wind. However, speak to your medical team for advice. If necessary and appropriate, they can prescribe medication to help. They might also make adjustments to any other medication you’re taking.

Foods and drinks to choose

Foods and drinks that might help to improve and prevent flatulence include:

• potatoes, oats and linseeds 
• fruits low in fructose (a type of sugar), such as banana, grapes, strawberries, raspberries, honeydew/cantaloupe melon, orange, pineapple or rhubarb 
• ginger, for example, ginger beer, ginger tea, ginger biscuits, ginger cake or root ginger 
• peppermint, for example, peppermint tea, or as peppermint oil.

Foods and drinks to avoid

Foods and drinks that might make flatulence worse include:

• fizzy (carbonated) drinks
• alcohol
• fruit juice
• artificial sweeteners.

Lifestyle

• Limit the amount of air you swallow – avoid smoking, chewing gum and sucking foods.
• Take regular gentle exercise.
• Eat little and often throughout the day.

Back to top

What treatment is there for wind?

Your medical team might recommend something to help ease wind, for example:

• charcoal tablets, to soak up gas within your digestive system 
• simeticone, to help wind pass more easily through your body

These medicines are available without prescription. However, always seek advice from your doctor before taking them. This is particularly important if you are having lymphoma treatment because it is possible for medicines to interact with one another in unwanted ways. This could make them less effective or cause other side effects.
Back to top