Chemotherapy : Diarrhea, Constipation, Nerve and Muscle, Skin and Nails

by National Cancer Institute

(Page 6 of 10)

Diarrhea

When chemotherapy affects the cells lining the intestine, it can cause diarrhea (watery or loose stools). If you have diarrhea that continues for more than 24 hours, or if you have pain and cramping along with the diarrhea, call your doctor. In severe cases, the doctor may prescribe a medicine to control the diarrhea. If diarrhea persists, you may need intravenous (IV) fluids to replace the water and nutrients you have lost. Often these fluids are given as an outpatient and do not require hospitalization. Do not take any over-the-counter medicines for diarrhea without asking your doctor.

How can I help control diarrhea?

• Drink plenty of fluids. This will help replace those you have lost through diarrhea. Mild, clear liquids, such as water, clear broth, sports drinks such as Gatorade, or ginger ale, are best. If these drinks make you more thirsty or nauseous, try diluting them with water. Drink slowly and make sure drinks are at room temperature. Let carbonated drinks lose their fizz before you drink them.

• Eat small amounts of food throughout the day instead of three large meals.

• Unless your doctor has told you otherwise, eat potassium-rich foods. Diarrhea can cause you to lose this important mineral. Bananas, oranges, potatoes, and peach and apricot nectars are good sources of potassium.

• Ask your doctor if you should try a clear liquid diet to give your bowels time to rest. A clear liquid diet does not provide all the nutrients you need, so do not follow one for more than 3 to 5 days.

• Eat low-fiber foods. Low-fiber foods include white bread, white rice or noodles, creamed cereals, ripe bananas, canned or cooked fruit without skins, cottage cheese, yogurt without seeds, eggs, mashed or baked potatoes without the skin, pureed vegetables, chicken, or turkey without the skin, and fish.

• Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber foods include whole grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn, and fresh and dried fruit.

• Avoid hot or very cold liquids, which can make diarrhea worse.

• Avoid coffee, tea with caffeine, alcohol, and sweets. Stay away from fried, greasy, or highly spiced foods, too. They are irritating and can cause diarrhea and cramping.

• Avoid milk and milk products, including ice cream, if they make your diarrhea worse.

Constipation

Some anticancer medicines, pain medicines, and other medicines can cause constipation. It can also occur if you are less active or if your diet lacks enough fluid or fiber. If you have not had a bowel movement for more than a day or two, call your doctor, who may suggest taking a laxative or stool softener. Do not take these measures without checking with your doctor, especially if your white blood cell count or platelets are low.

What can I do about constipation?

Drink plenty of fluids to help loosen the bowels. If you do not have mouth sores, try warm and hot fluids, including water, which work especially well.

Check with your doctor to see if you can increase the fiber in your diet (there are certain kinds of cancer and certain side effects you may have for which a high-fiber diet is not recommended). High fiber foods include bran, whole-wheat breads and cereals, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn.

Get some exercise every day. Go for a walk or you may want to try a more structured exercise program. Talk to your doctor about the amount and type of exercise that is right for you.

Nerve and Muscle Effects

Sometimes anticancer drugs can cause problems with your body's nerves. One example of a condition affecting the nervous system is peripheral neuropathy, where you feel a tingling, burning, weakness, or numbness or pain in the hands and/or feet. Some drugs can also affect the muscles, making them weak, tired, or sore.

Sometimes, these nerve and muscle side effects, though annoying, may not be serious. In other cases, nerve and muscle symptoms may be serious and need medical attention. Be sure to report any nerve or muscle symptoms to your doctor. Most of the time, these symptoms will get better; however, it may take up to a year after your treatment ends.

Some nerve and muscle-related symptoms include:

• tingling
• burning
• weakness or numbness in the hands and/or feet
• pain when walking
• weak, sore, tired or achy muscles
• loss of balance
• clumsiness
• difficulty picking up objects and buttoning clothing
• shaking or trembling
• walking problems
• jaw pain
• hearing loss
• stomach pain
• constipation

How can I cope with nerve and muscle problems?

• If your fingers are numb, be very careful when grasping objects that are sharp, hot, or otherwise dangerous.
• If your sense of balance or muscle strength is affected, avoid falls by moving carefully, using handrails when going up or down stairs, and using bath mats in the bathtub or shower.
• Always wear shoes with rubber soles (if possible).
• Ask your doctor for pain medicine.

Effects on Skin and Nails

You may have minor skin problems while you are having chemotherapy, such as redness, rashes, itching, peeling, dryness, acne, and increased sensitivity to the sun. Certain anticancer drugs, when given intravenously, may cause the skin all along the vein to darken, especially in people who have very dark skin. Some people use makeup to cover the area, but this can take a lot of time if several veins are affected. The darkened areas will fade a few months after treatment ends.

Your nails may also become darkened, yellow, brittle, or cracked. They also may develop vertical lines or bands.

While most of these problems are not serious and you can take care of them yourself, a few need immediate attention. Certain drugs given intravenously (IV) can cause serious and permanent tissue damage if they leak out of the vein. Tell your doctor or nurse right away if you feel any burning or pain when you are getting IV drugs. These symptoms do not always mean there is a problem, but they must always be checked at once. Don't hesitate to call your doctor about even the less serious symptoms.

Some symptoms may mean you are having an allergic reaction that may need to be treated at once. Call your doctor or nurse right away if:

• you develop sudden or severe itching.
• your skin breaks out in a rash or hives.
• you have wheezing or any other trouble breathing.

How can I cope with skin and nail problems?

Acne

• Try to keep your face clean and dry.
• Ask your doctor or nurse if you can use over-the-counter medicated creams or soaps.

Itching and dryness

• Apply corn starch as you would a dusting powder.
• To help avoid dryness, take quick showers or sponge baths. Do not take long, hot baths. Use a moisturizing soap.
• Apply cream and lotion while your skin is still moist.
• Avoid perfume, cologne, or aftershave lotion that contains alcohol.
• Use a colloid oatmeal bath or diphenhydramine for generalized pruritis.

Nail problems

• You can buy nail-strengthening products in a drug store. Be aware that these products may bother your skin and nails.
• Protect your nails by wearing gloves when washing dishes, gardening, or doing other work around the house.
• Be sure to let your doctor know if you have redness, pain, or changes around the cuticles.

Sunlight sensitivity

• Avoid direct sunlight as much as possible, especially between 10 a.m. and 4 p.m. when the sun's rays are the strongest.
• Use a sun screen lotion with a skin protection factor (SPF) of 15 or higher to protect against sun damage. A product such as zinc oxide, sold over the counter, can block the sun's rays completely.
• Use a lip balm with a sun protection factor.
• Wear long-sleeve cotton shirts, pants and hats with a wide brim (particularly if you are having hair loss), to block the sun.
• Even people with dark skin need to protect themselves from the sun during chemotherapy.

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