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Summary

Diarrhea (sometimes referred to as "multiple poop syndrome or MPS) is most often defined as 2 or more loose stools in a 4-hour time period.

It is important to treat diarrhea as soon as it starts. Continuing diarrhea can lead to dehydration which not only feels lousy, it can lead to complications such as kidney failure.

There are over-the-counter remedies that help control diarrhea, as well as more powerful prescription drugs. Do not take an over-the-counter remedy without checking with your doctor first -- particularly if your diarrhea is caused by a treatment.

If you have diarrhea that lasts for more than 24 hours, or if you have pain and cramping along with it, call your doctor or other health care provider. 

If your diarrhea doesn't get better, you may need to see a doctor to get IV fluids to replace lost water and nutrients.

For additional information, see:

 

 

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Chemotherapy: Side Effects

What Diarrhea Is

Diarrhea is frequent bowel movements which may be soft, formed, loose, or watery.

Causes of Diarrhea

Diarrhea can be caused by any of the following:

  • Medications.
  • Your health condition.
  • A treatment such as surgery, chemotherapy, or radiation.

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What Food And Liquid To Avoid When You Have Diarrhea

WHEN YOU HAVE DIARRHEA:

Do Not Drink:

  • Milk 
  • Drinks that are very hot or very cold.
  • Beer, wine and other types of alcohol.
  • Soy and other soy products
  • Beverages sweetened wit h sorbi tol
  • Large amounts of caffeinated products such as coffee or tea. According to Mayo Clinic, research indicates that caffeine has a diuretic effect if you consume large amounts of it — more than 500 to 600 milligrams (the equivalent of 5 to 7 cups of coffee) a day. One or two cups a day are okay.

Do Not Eat:

  • Milk and other dairy products such as ice cream, sour cream and cheese.. They make diarrhea worse.
  • Fried foods, greasy foods, or foods with a lot of spice in them such as hot sauce, salsa, chili and curry dishes.
  • Foods that cause gas. For instance:
    • Cooked dried beans
    • Cabbage
    • Broccoli 
    • Soy milk and other soy products. 
  • Chocolates.
  • High fiber foods. For a list of high fiber foods, click here
  • Raw foods.
  • Irritating foods such as sweets and highly spiced foods.
  • Foods with a laxative effect such as prunes, prune juice, apple juice and pear juice.

Over The Counter And Prescription Medications To Treat Diarrhea

There are over the counter medications such as Immodium that help treat diarrhea. 

Follow the instructions on the container. However, if the diarrhea is more like a watery liquid (not just loose bowels), experienced patient advocates have found that Immodium can be more effective if taken every two hours for 12 hours straight. It doesn't matter if the condition continues - one episode of watery diarrhea is enough to trigger the suggestion. DO NOT take this suggestion without checking with your health care team first.

You will know rather quickly whether the Immodium stops your diarrhea. If not, call your doctor iimmediately. 

  • In severe cases, your doctor may prescribe an anti-diarrheal medicine such as Sandostatin®, a long acting injection, or over-the-counter Loperamide offsite link
  • If the prescription is for a drug that requires the pharmacy to reveive a written prescription before providing the drug, some pharmacies will provide a temporary supply that can hold you until the actual prescription arrives at the pharmacy. 
  • If you get a prescription for "just in case" - keep in mind that prescriptions expire after a period of time and you will have to get a new prescription before the pharmacy will fill it.

NOTE: As a practical matter, it is usually advisable to start treating diarrhea with a medication such as Immodium rather than a stronger medication. Stronger medications can lead to constipation, which then has to be treated. Constipation and diarrhea can become a back and forth seesaw making you very uncomfortable in the process. (For information about dealing with constipation, click here.)

What You Can Do To Help Manage Diarrhea In Addition To Medications

CHECK WITH YOUR DOCTOR OR OTHER HEALTH CARE PROFESSIONAL TO TAILOR THE FOLLOWING IDEAS TO YOUR SITUATION. THE IDEAS  WERE COMPILED BY EDEN STOTSKY-HIMELFARB, BSN, RN 

Change your drinking habits.

Each day, consume at least 8 - 12 servings (8oz. each) of clear, non-carbonated, liquid to make up for the fluid you lose through diarrhea.

  • For a list of drinks that are considered to be "Clear Liquid", click here.
  • Drink liquids at room temperature - without ice. 
  • Drink fluids slowly.
  • Let carbonated drinks lose their fizz before you drink them. 
  • If you want drinks which are high in sugar, ask your doctor, nurse or dietitian if you should dilute them with water.
  • Avoid the following:
    • Alcohol
    • Caffeine
    • Milk and dairy products

Through out the day, eat many small meals and snacks of foods that are easy on the stomach. 

By trial and error, you will discover which foods you can tolerate.

Foods that are easy on the stomach include the following: white bread, boiled potatoes, chicken or turkey (broiled or baked without the skin), crackers, cream of wheat, oatmeal, white rice, noodles, ripe bananas, canned or cooked fruit without skins, eggs, pureed vegetables, yogurt and fish. 

Choose foods that help to replace electroylytes which are lost with diarrhea.  This includes fruits and vegetables that have a lot of potassium and sodium in them such as bananas, peach nectar, apricot nectar, oranges and potatoes. Diarrhea can take potassiium out of your system.

Try to eat foods that bulk stool. For example: 

  • Applesauce
  • Bananas
  • Cooked carrots
  • Low insoluble fiber foods such as:
    • Canned or cooked fruit without skin
    • Cream of Wheat
    • Fish
    • Mashed potatoes
    • Noodles
    • Oatmeal
    • Rice
    • Skinned turkey or chicken
    • Well cooked eggs
    • White toast

When diarrhea is severe, doctors often recommend what is known as a BRAT diet. BRAT stands for:

  • banana
  • rice
  • applesauce
  • toast.

Try dry fiber

While fiber supplements are usually used for constipation, they can be used for diarrhea if taken without liquid for one meal a day for up to 3 days. The dry fiber will soak up excess fluid in your digestive tract. (The fiber may also produce gas).

  • Take the prescribed amount of supplement immediately after a meal with very little liquid. 
  • Don't drink for an hour.

For diarrhea caused by specific treatments: 

  • For chemotherapy induced diarrhea (CID)
    • Ioperamide the standard first line of therapy. A popular brand available without a prescription.is Imodium.
    • A somatostatin analog (octreotide acetate)
    • Tincture of opium
  • For radiation induced diarrhea, consider the following:
    • Imodium
    • Lomotil
    • Oral opiates

Take care of your rectal area. 

  • Instead of toilet paper,  clean yourself after bowel movements with a baby wipe or squirt of water from a spray bottle. (Note: do not flush baby wipes into a septic tank.)
  • Ask your nurse about taking sitz baths, which is a warm-water bath taken in a sitting position that covers only the hips and buttocks. 
  • Consider using an over-the-counter treatment for hemmerhoids to anesthetize the area so there is no feeling.
  • Be sure to tell your doctor or nurse if your rectal area gets sore.

Contact your doctor or other health care provider if: 

  • Your diarrhea is severe (you have pain, cramping or 7 or 8 loose movements in 24 hours) OR
  • Your diarrhea continues for more than 24 hours.