Pancreatic Cancer and Diarrhea

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What is diarrhea and when does it occur?

Diarrhea is generally described as abnormally frequent bowel movements that are more fluid than usual. Patients describe it based on their past and present experiences; therefore, what is normal for one person may be considered diarrhea to another. Often, health professionals characterize diarrhea as 4 or more loose stools per day. It is a common side effect experienced by many patients with cancer.

Diarrhea may be caused by:

• lactose intolerance
• bacterial infection
• damage to intestinal wall
• hormone-producing tumors (including certain types of pancreatic neuroendocrine tumors)
• inflammation or ulceration of the bowel
• malabsorption caused by surgery that has shortened the intestines
• pancreatic enzyme insufficiency
• chemotherapy
• radiation therapy to the lower abdomen
• dumping syndrome.
• certain medications

People may experience different types of diarrhea. Clay-colored stools are often a result of problems with or obstructions of the biliary tract. The biliary tract is the drainage system for the gall bladder, pancreas and liver. Biliary tract blockages are common for patients with pancreatic cancer.

Floating stools often result from poor absorption of nutrients or changes in the diet, such as increased fiber. Malabsorption is common for patients with pancreatic cancer because the pancreas may not be able to produce or release enough pancreatic enzymes to aid in proper food digestion.

If a patient experiences diarrhea, a journal may be helpful to track the onset, frequency, duration, stool consistency and self-care measures taken to control it. It is helpful to share this written record with the doctor or dietitian to help devise a plan to manage the diarrhea. Since diarrhea can cause dehydration, it may also be helpful to keep track of fluid intake.

Discuss with the doctor the use of pancreatic enzyme replacement products. If the levels of enzymes produced naturally by the pancreas are insufficient, the patient may experience diarrhea.  The doctor will prescribe the type, dosage and administration schedule based on individual need, symptoms and quantity of food intake.

Regardless of the cause of diarrhea, the following diet modifications may help decrease the volume and frequency of stools.

The following foods may worsen diarrhea:

• Fatty, greasy or fried foods, including high fat meats or cheeses, whole or 2% milk, rich desserts, many fast foods and foods with added oil, butter, margarine, sour cream, cream cheese or salad dressing.
• High intake of insoluble fiber food sources during occurrences of diarrhea.  Foods such as whole grain breads/cereals, raw fruits with thick peels, raw vegetables and nuts can make foods move faster through the intestines.
• Gas-forming foods, including vegetables in the cabbage or onion family, dried beans, corn, popcorn and chewing gum.  If carbonated beverages are used, leaving them open for at least 10 minutes prior to drinking may help reduce.
• Foods high in sugar may cause diarrhea due to dumping syndrome. The symptoms of dumping syndrome include watery diarrhea or feelings of low blood sugar that occur within 30 minutes to 2 hours after eating high-sugar foods. Symptoms of low blood sugar include flushing, faintness and sweating.
• Hot liquids.
• Products made with regular milk if lactose intolerance is present or develops.
• Foods sweetened with sugar alcohols (type of reduced-calorie sweetener such as sorbitol, mannitol and xylitol).

The following foods are less likely to aggravate diarrhea:

• Low fat food choices.
• Foods that contain soluble fiber, such as oat fiber, and high-pectin foods like applesauce and bananas.
• If lactose intolerance is present or develops, it may help to consume plant based milk alternatives, such as soy or rice milk, or dairy products with added lactase (Lactaid®). Lactaid® Fast Act caplets or chewable tablets can also be taken with dairy products instead of milk alternatives.

Other supportive care techniques:

• Plan to eat 6-8 small meals and snacks each day.
• Talk to the healthcare team including the doctor or registered dietitian about pancreatic enzymes or other anti-diarrhea medications that may be appropriate.
• Drink plenty of fluids.
• Over-the-counter anti-diarrhea medicines:
  • Loperamide:  Slows down the time it takes food to travel through the intestinal tract (e.g., Imodium A-D® and Imodium®).
  • Adsorbents: Attract diarrhea-causing substances from the digestive tract (e.g., Pepto-Bismol® and Kapectolin®).
  • Absorbents: Make stools more solid by adding bulk (e.g., Metamucil®, Benefiber® and Konsyl®).
• Prescription anti-diarrhea medicines:
  • Opioids:  Slow down the time it takes food to travel through the intestinal tract (e.g., Lomotil® and tincture of opium).
  • Anticholinergics:  Relieve spasms and cramping (e.g., atropine, belladonna and scopolamine).
  • Somatostatin analogues:  Reduce the secretion of extra fluid and help the body reabsorb valuable water and electrolytes.  They also slow down the time it takes food to travel through the intestinal tract (e.g., Sandostatin®).
• Drink plenty of fluids.
• The use of probiotics appears helpful in improving tolerance of and support for treatment and radiation-related diarrhea. Further research is needed to confirm the effects of probiotics when used in patients with pancreatic cancer. Sources of probiotics include foods such as yogurt, kefir, buttermilk, tempeh, sauerkraut and cottage cheese. Therapeutic foods such as DanActive™, Activia® and dietary supplements such as Align®, Culturelle® and Florastor® also contain probiotics.

Diarrhea and Dehydration

Diarrhea can cause dehydration. Dehydration results in the loss of fluids and electrolytes, including sodium and potassium, from the body.

Here are some suggestions to avoid dehydration:

• Drink 48–96 ounces of mild, clear liquids throughout the day to replace fluid loss from diarrhea.  Liquids are better tolerated at room temperature.
• Avoid beverages that contain caffeine such as coffee, tea and sodas.
• Drink an additional cup of fluids for each loose bowel movement.
• Check with the doctor to see if sports drinks or electrolyte replacement drinks (e.g., Gatorade®, G2®, Pedialyte® or Ceralyte70®) may be beneficial.
• Replace lost sodium with slightly warm broth or soup, crackers, pretzels, and sports drinks or electrolyte replacement drinks.
• Replace lost potassium by drinking fruit juices, sports drinks or electrolyte replacement drinks, or by eating peeled potatoes and bananas.

We’re Here to Help

For more information on diet and nutrition or for free, in-depth and personalized resources and information on pancreatic cancer, contact a PanCAN Patient Services Case Manager.

Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note any personal information you provide to PanCAN’s staff during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and education efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so. For more information on how we may use your information, you can find our privacy policy on our website at https://www.pancan.org/privacy/.