Gastrointestinal disturbances - Myeloma UK
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Gastrointestinal
disturbances
This Infosheet explains what gastrointestinal disturbances are, what
causes nausea, vomiting, constipation and diarrhoea in myeloma
patients, how they are treated and some tips for self-management.
What are gastrointestinal a few days) or chronic (persisting for
disturbances? longer periods of time, usually more
Gastrointestinal (GI) disturbances than two weeks).
are issues involving your stomach Severe or long-term vomiting,
and intestines. This can include constipation or diarrhoea can lead
nausea, vomiting, constipation and to more serious conditions, so any
diarrhoea. These are very common vomiting or change in your normal
side effects in myeloma patients, bowel habits should be reported
and can upset normal day-to-day life to your doctor or nurse. If you feel
and be distressing to live with. awkward or embarrassed discussing
GI disturbances can be acute your bowel habits, try to remember
(lasting for a short time only, such as that your doctor and nurse will be
Myeloma Symptoms and
Infosheet complications
Series
Infoline: 0800 980 3332 1used to talking about it and that If you find blood (either bright red
they are there to help prevent and or dark and like coffee grounds) in
manage any side effects of myeloma your vomit you should seek medical
and its treatment. advice immediately.
What are the causes of nausea and
Nausea and vomiting in myeloma patients?
vomiting Nausea and vomiting are very
common in myeloma patients. They
What are nausea and vomiting? can be due to a number of reasons.
Nausea is a feeling of queasiness, Myeloma treatment and
unease and discomfort in the upper supportive treatment
stomach, with an urge to throw up or
be sick (vomit). Treatment for myeloma is the
most common cause of nausea
You may not necessarily vomit if you and vomiting in myeloma patients.
have nausea. They are common side effects
of chemotherapy drugs, such as
What are the symptoms of nausea cyclophosphamide and melphalan,
and vomiting? and other anti-myeloma drugs, such
The symptoms of nausea and as bortezomib.
vomiting include: Some supportive treatments can
Feeling like you need to vomit or also cause nausea and vomiting.
actually vomiting For example, some people can feel
Queasiness sick during or after radiotherapy.
Antibiotics and some painkillers can
Dizziness
cause nausea and vomiting too.
Excessive sweating and
If you have previously been affected
clamminess
by nausea and vomiting during
Dry mouth treatment, you may anticipate
Severe or persistent vomiting can that you will experience the same
lead to: symptoms again. This can induce a
type of nausea called anticipatory
Dehydration
nausea.
Stomach pain
Damage to the throat
2 www.myeloma.org.ukInfection Treatment for other illnesses or
Certain bacterial and viral infections conditions may also cause nausea
cause nausea and vomiting. These and vomiting. You can check
infections are often contagious, so whether any other treatment you
if you have been around others who are having can cause nausea and
have had stomach bugs it is not vomiting by consulting the patient
uncommon to pick up an infection information leaflet (PIL) included
too, especially because myeloma in the drug pack. You should make
patients have a higher risk of your doctor or nurse aware of any
developing infections. other treatments you are taking for
other illnesses or conditions.
Other symptoms of an infection
include diarrhoea, abdominal How are nausea and vomiting
cramps and pain, a high temperature treated?
and loss of appetite.
Anti-emetics
For more information see the Infection and Nausea and vomiting are usually
myeloma Infosheet from Myeloma UK
treated with anti-emetics, for
example metoclopramide,
Stress, anxiety and nervousness granisetron and ondansetron. They
Strong emotions, in particular stress, will be prescribed along with your
anxiety and nervousness, can make myeloma treatment to prevent or
you feel sick or vomit. minimise these side effects.
You should take your anti-emetic
For more information see the Infopack for medications regularly as prescribed.
living well with myeloma from Myeloma UK Do not wait until you feel sick, as the
drugs won’t be as effective this way.
Pain If you find the anti-emetics you have
Severe pain can cause nausea and/ been prescribed are not effective
or vomiting. when taking them as prescribed, ask
to try a different one as there are
Other illnesses and conditions several types available.
Other illnesses and conditions can
Other treatments
be responsible for causing nausea
and vomiting, for example, diabetes If your nausea and/or vomiting
or travel sickness. are not directly caused by your
myeloma treatment, you may be
Infoline: 0800 980 3332 3given treatments other than anti- sick, try putting light perfume
emetics to help. This could include onto a handkerchief that you can
painkillers, antibiotics or relaxation use to help mask the smell
aids like complementary therapies. Certain scents may help, for
example lavender. Speak to a
Tips for self-management complementary therapist who
It is important to keep drinking should be able to recommend
as vomiting can dehydrate you. some aromatherapy scents to
Allow your stomach to rest after help with your nausea
vomiting then sip drinks such as Try to take your mind off how
still or sparkling water or fizzy you feel – talk to people, watch a
drinks film or listen to soothing music to
Ginger may help settle your distract yourself
stomach. Try ginger tea, non- Relaxing breathing exercises or
alcoholic ginger beer/ale or ginger lying down in a darkened room
biscuits may help to reduce feelings of
Mint can also help with nausea. nausea
Try mint tea, mints or chewing Fresh air may help – try sitting
gum outside or near an open window
Eat little and often. Snacking on Calm your anxiety or stress with
plain, cold or room-temperature relaxation techniques
food may be more palatable than
hot meals. If you can’t face eating If vomiting is severe, fluid can be
solid food, high calorie drinks may replaced by special preparations
be more tolerable available through your GP or from
a chemist
Avoid spicy, fatty or acidic foods
Avoid your favourite foods to
prevent you associating them with
nausea and vomiting
Avoid strong smells if they
exacerbate your nausea, for
example avoid cooking or keep
the window open during food
preparation
If hospital smells make you feel
4 www.myeloma.org.ukConstipation A feeling that you have not
completely emptied your bowels
What is constipation? If constipation is not treated it can
cause more severe symptoms,
Constipation is defined as having
including:
difficulty emptying your bowels.
When you are constipated, bowel Swollen, painful stomach, often
movements occur less often than accompanied by stomach cramps
they would normally and they may Loss of appetite
be dry, hard and painful.
Nausea
It is important to know what your
Vomiting
normal bowel pattern is because
constipation is relative to your usual Excessively runny diarrhoea – this
habits and this varies between may occur if you bowel is blocked
patients. Some people have two with hard faeces
or three bowel movements a day Headache and thirst
whereas for others three or four
movements per week might be What are the causes of
more normal. constipation in myeloma patients?
It is worth remembering that in the There are several reason why
majority of people, the digestive you may have constipation as a
system slows down with age, so as myeloma patient. It is important
you get older, you may need to move to know what has caused your
your bowels less often. constipation, as this will help both
you and your doctor or nurse treat it
What are the symptoms of effectively.
constipation?
Myeloma treatment and
The symptoms of constipation
supportive treatment
include:
Some treatments for myeloma can
Fewer than three bowel
cause constipation as they slow
movements a week
the moving of faeces through the
Pain or discomfort when opening bowel. This causes more water to be
your bowels removed from the faeces, resulting
Passing small hard stools in dry, hard stools.
Feeling bloated and tired Treatments and supportive
Infoline: 0800 980 3332 5treatments that may cause Dehydration
constipation include: Your body needs a lot of fluid to help
Thalidomide, lenalidomide move food through your intestines
(Revlimid®) and bortezomib and also to keep your faeces soft.
(Velcade®) If you are not drinking enough fluid
Anti-sickness drugs (e.g. and you become dehydrated, your
granisetron, ondansetron) faeces will become hard and you
may have difficulty opening your
Some chemotherapy drugs (e.g. bowels.
vincristine)
Most strong painkillers (e.g. Lack of exercise/poor mobility
codeine, tramadol, oramorph ) ®
If you are unable to exercise or it
is hard for you to get around then
Hypercalcaemia you may lose muscle tone in your
Myeloma bone disease can increase stomach area and in your intestine.
the amount of calcium in your blood As these muscles are needed
which can cause hypercalcaemia. to help move food through the
Symptoms of hypercalcaemia digestive tract, the decrease in
include constipation and muscle tone can cause constipation.
dehydration, as well as increased Prolonged sitting can also lead
thirst and confusion. to constipation, as the effects of
gravity can help to move food
For more information see the Myeloma bone through your intestines.
disease and bisphosphonates Infoguide from
Myeloma UK
Stress, anxiety and depression
Periods of prolonged stress,
Poor diet/loss of appetite
anxiety or depression may cause
If your diet is lacking in essential constipation.
nutrients, particularly fibre, then
you are more likely to become For more information see the Infopack for
constipated. Fibre helps keep your living well with myeloma from Myeloma UK
bowels healthy and active. It also
helps keep your faeces soft and Change in routine
increases the speed with which
your food is digested. You may not Many people become constipated
be eating enough fibre if you have a as a result of a change in their
supressed appetite. daily routine – this can sometimes
6 www.myeloma.org.ukhappen during a stay in hospital self-management and an over-the-
when your normal diet is disrupted counter treatment. However, if your
or if you are travelling long distances constipation persists for more than
to appointments. a few days, you should speak to your
doctor or nurse.
Other illnesses and conditions and
their treatments Laxatives
Other illnesses and conditions If your doctor decides that you need
that some myeloma patients may a prescription treatment for your
have can cause constipation, constipation you are likely to be
for example Parkinson’s disease prescribed a laxative. Laxatives are
or an underactive thyroid a group of oral drugs used to relieve
(hypothyroidism). constipation. They are available as
Treatments for other illnesses tablets, liquids and powders.
or conditions may also cause If you are taking any treatments that
constipation, for example some anti- are known to cause constipation
depressants (e.g. amitriptyline). (e.g. strong painkillers) then it
You can check whether any other may be worth checking with your
treatment you are having can cause doctor to see if you need to take a
constipation by consulting the mild laxative regularly to prevent
PIL included in the drug pack. You constipation.
should make your doctor or nurse Table 1 outlines the different types
aware of any other treatments you of laxatives that are commonly
are taking for other illnesses or available for constipation and their
conditions. possible side effects.
How is constipation treated? Other treatments
There are many over-the-counter If your constipation is not relieved by
remedies available to relieve oral laxatives, then you may need to
constipation as well as a number of have a suppository or an enema.
prescription-only treatments your These are treatments given directly
doctor may consider. into your back passage and,
If you notice symptoms of though uncomfortable, they can
constipation, you may benefit be extremely effective at relieving
from first visiting your local acute constipation. It is important,
pharmacists for practical advice on however, that you only use
Infoline: 0800 980 3332 7Type Examples How they work Side effects Notes
Bulk Fybogel Supplement Bloating Not suitable
forming Celevac dietary fibre and swollen for immediate
laxatives Increase weight stomach, relief
Normacol wind
and softness of Must be taken
faeces with at least
Can take several one glass of
days to work water
Stimulant Senna Cause the Stomach To be taken at
laxatives Bisacodyl muscles in cramps and night
the bowel to swelling,
Co- contract wind
danthramer
Can take 8 – 12
hours to work
Osmotic Lactulose Increase the Stomach Must be taken
laxatives Lactitol amount of water cramps and under medical
retained in swelling, supervision
Magnesium the intestines, wind, colic
salts therefore type pain
making the
faeces softer
Can take up to 3
days to work
Stool Arachis oil Increase the
softener Docusate fluid content of
laxatives sodium stools making
them softer
Table 1. Types of laxatives used to treat constipation.
suppositories and enemas under the platelet count is low.
advice of your doctor or nurse: this
is because they should not be used Natural treatments
regularly, and could cause bleeding There are many natural treatments
from your back passage if your available to treat constipation, most
8 www.myeloma.org.ukof which can be bought without a cakes, sugar
prescription. Ensure that you are well hydrated
These include: – drink 2-3 litres of water a day.
Fibre supplements e.g. bran or Hot drinks, such as decaffeinated
psyllium husks – these must be coffee, tea or hot water with a slice
taken with at least one glass of of lemon may help to stimulate a
water bowel movement, especially if had
with breakfast
Flaxseed (or linseed) oil or seeds
– these must also be taken with at Avoid caffeine, because
least one glass of water although it can stimulate your
bowels, caffeine can also cause
Syrup of figs – a natural fruit dehydration which can make
remedy constipation worse
Sometimes natural treatments can Avoid alcohol because it can also
interact with other treatments that cause dehydration and make your
you may be taking so it is important constipation worse
to inform your doctor or nurse about
any natural treatments that you wish Try to incorporate gentle exercise
to try. into your day. This can be walking,
swimming or other low-impact
Tips for self-management and exercises. If you have difficulty
prevention exercising, moving your muscles
and limbs while sitting may help
There are many things you can try to
help prevent constipation or reduce Try to minimise the stress in your
its severity. These include: life. Relaxation exercises can often
help, as can talking about your
Increase the amount of fibre
worries
in your diet. High fibre foods
include bran-based cereals, fruit, Aim to have a regular time when
vegetables, beans, pulses and you go to the toilet, for example
wholegrain bread shortly after breakfast. If possible
try not to hurry and avoid
Eat prunes and other dried fruits
straining when trying to open your
If your appetite is poor then eating bowels
small amounts of high fibre foods
Use a footrest while you are going
throughout the day may help
to the toilet to raise your knees
Limit the amount of refined food above your hips
that you eat e.g. white bread,
Infoline: 0800 980 3332 9Diarrhoea What are the causes of diarrhoea
in myeloma patients?
What is diarrhoea? Myeloma treatment
Diarrhoea is the passing of loose or Some treatments for myeloma can
watery stools more than three times cause diarrhoea. They include the
a day. drugs bortezomib and panobinostat
If you have diarrhoea, it is important (Farydak®), which can cause acute
to deal with it straight away, as onset diarrhoea, meaning it can
excessive loss of water through occur within 24 hours of treatment
your stools can lead to dehydration, beginning.
which can be serious. Dehydration Other established treatments for
is more likely to occur and is more myeloma such as lenalidomide and
serious in the elderly. pomalidomide (Imnovid®) can cause
Diarrhoea can have a significant late onset diarrhoea which may
impact on your quality of life. It can start many months after treatment
make you anxious about leaving beginning.
your home and make you feel limited
in what you can do. Infection
Certain bacterial and viral infections
What are the symptoms of cause diarrhoea. These infections
diarrhoea? are often contagious, so if you have
The symptoms of diarrhoea include: been around others who have had
stomach bugs it is not uncommon
More than three loose or water
to pick up an infection too, especially
bowel movements per day because myeloma patients have a
Cramping stomach pains higher risk of developing infections.
An urgent need to go to the toilet Other symptoms of an infection
Nausea or vomiting include nausea, vomiting,
abdominal cramps and pain, a high
Fever
temperature and loss of appetite. It
Headache is important to tell your doctor if you
Loss of appetite suspect your diarrhoea is cause by
an infection.
For more information see the Infection and
myeloma Infosheet from Myeloma UK
10 www.myeloma.org.ukConstipation and laxatives treatment you are having can
Excessively water or runny cause diarrhoea by consulting the
diarrhoea may occur as a result PIL included in the drug pack. You
of constipation, as your bowel is should make your doctor or nurse
blocked with hard faeces, so only aware of any other treatments you
loose and watery stools can make are taking for other illnesses or
their way past the blockage. conditions.
Laxatives used to treat constipation How is diarrhoea treated?
can also cause diarrhoea.
Your doctor will assess the cause of
Stress, anxiety and depression your diarrhoea to determine what
treatment is right for you.
Periods of prolonged stress, anxiety
or depression may cause diarrhoea. If your diarrhoea is a side effect
of your myeloma treatment, your
For more information see the Infopack for doctor may adjust your treatment
living well with myeloma from Myeloma UK schedule, reduce the dose or
temporarily stop treatment until it
Bile Acid Malabsorption (BAM) improves. If the diarrhoea does not
improve after these adjustments,
BAM is a condition where patients it may be necessary to stop the
do not absorb bile acids properly treatment altogether and find an
from their intestine. This can cause alternative instead.
diarrhoea and has been identified
as the cause of diarrhoea in some Often other causes of diarrhoea, like
patients taking lenalidomide. a mild stomach upset, can resolve
themselves and so treatment for
Other illness and conditions and diarrhoea may not be necessary.
their treatment However, any complications that
have arisen, such as dehydration, will
Other illnesses and conditions
need to be treated.
can cause diarrhoea, for example
inflammatory bowel disease (IBS) or Prescribed treatments
coeliac disease.
If your doctor decides that you
Treatments for other illnesses need treatment for your diarrhoea
or conditions may also cause then you may be prescribed a
diarrhoea, for example antibiotics. treatment to slow down the motility
You can check whether any other (movement) of the bowel, examples
Infoline: 0800 980 3332 11Type Examples Side effects
Antimotility drugs Loperamide Abdominal cramps,
(Norimode, Imodium) dizziness, drowsiness
and skin reactions
Opioid painkillers Codeine phosphate Abdominal pain
Morphine
Antispasmodic drugs Dicycloverine Bloating, heartburn,
Hyoscine butylbromide constipation, dry
(Buscopan) mouth
Atropine
Table 2. Types of treatment for diarrhoea.
of which are listed Table 2. the best course of treatment for the
infection and diarrhoea.
Over-the-counter treatments
Painkillers, like paracetamol, can
There are treatments for diarrhoea be taken to help any discomfort
available over-the-counter, for or pain experienced. However,
example Norimode®, Imodium® myeloma patients should not take
and Buscopan®, many of which non-steroidal anti-inflammatory
have the same active ingredients drugs (NSAIDs) such as ibuprofen as
as prescribed treatments. It is NSAIDs can worsen kidney damage
advisable to check with your doctor which is a common complication in
or nurse before you take any over- myeloma patients.
the-counter treatments and do not
take loperamide for more than two For more information see the Myeloma and
days for treatment of diarrhoea the kidney Infoguide from Myeloma UK
without checking with your doctor or
nurse.
BAM treatment
If your diarrhoea is caused by an
If you are found to have BAM,
infection, it is not advisable to use
you will need to modify your diet
over-the-counter treatments as
to reduce your fat intake. Your
these may ease symptoms without
doctor will usually also prescribe a
dealing with the underlying infection.
treatment, for example colesevelam.
Your doctor will be able to determine
12 www.myeloma.org.ukTreating complications of skin and instead try warm (not hot)
diarrhoea water baths, a bidet or a sitz bath
and allow the skin to air dry or gently
Dehydration dab the area dry.
Rehydration salts (for example Sitting down for long periods of time
Dioralyte™ and Electrolade®) can may worsen any soreness so try
treat dehydration due to diarrhoea. to avoid prolonged sitting and use
They provide a mixture of salts cushions to soften the seat.
needed by the body to replace those
that have been lost in your stools. Tips for self-management
Rehydration salts are available over-
There are ways to help manage
the-counter as a powder in sachets
diarrhoea at home:
or in tablet form and are dissolved in
water to drink. Keep hydrated by drinking clear
fluids such as water, diluted juice,
Skin discomfort sports drinks or soup/broth. Take
Frequent diarrhoea can cause frequent small sips rather than
discomfort to the skin around your drinking large amounts of fluid in
anus and it may become sore. one go
There are creams that can help to Avoid drinks that contain lots of
soothe the area and prevent the skin sugar (e.g. cola or fizzy drinks),
from breaking which can happen alcohol or caffeine
in severe cases of diarrhoea. Ask
Use rehydration salts
your doctor or nurse about soothing
creams. Try to keep eating small, frequent
meals made from light, plain foods
Frequent wiping can make the skin
– soup, potatoes, bananas, bread,
around your anus irritated, so use
pasta or rice. Avoid highly spiced
high quality, soft toilet tissue. You
or fatty foods that might upset
can also try using moist toilet tissue
your stomach and eat your meals
to wipe the area or damp cotton
slowly
wool, both of which can be less
aggravating than dry toilet tissue. Some bacteria found in live
Avoid any wipes which contain yoghurt or live-yoghurt drinks
alcohol. may help to ease diarrhoea
caused by antibiotics. Antibiotics
It is important to keep the area clean
can kill off the healthy bacteria
and dry as much as possible. Avoid
normally found in the bowel, but
using soaps which can irritate the
Infoline: 0800 980 3332 13the bacteria found in live yoghurt available which can help you access
may replace them. However, you the toilet more easily.
should avoid live yoghurt if your
white cell count is low. If you are Summary
unsure whether this affects you, It is important to be honest with
check with your doctor or nurse your doctor and nurse about any
Plan ahead and find out where the gastrointestinal disturbances you
nearest toilet is if you need to go are having.
out, so if you need to get to a toilet If left untreated, nausea, vomiting,
quickly you know there is one constipation and diarrhoea can
nearby have a significant impact on your
Be prepared and keep a change quality of life and lead to serious
of clothes, spare toilet roll and a complications, so report any
bottle of water in your car or a bag changes to your doctor and nurse
if you are out of the house as early as possible. This will enable
Wear clothes that are easy to pull them to help manage the issues as
on and off, that are comfortable quickly as possible.
and not too tight, such as trousers
About this Infosheet
with elasticated waists
The information in this Infosheet
Wear cotton underwear
is not meant to replace the advice
Always wash your hands with of your medical team. They are the
soap after going to the toilet. If people to ask if you have questions
your hands are getting dry from about your individual situation.
the soap, use a hand moisturiser
For a list of references used to
after washing
develop our resources, visit
It is not uncommon to have an www.myeloma.org.uk/references
accident if you have diarrhoea. If you
To give feedback about this
can’t get to the toilet easily because
publication, email
you have difficulty with mobility or
myelomauk@myeloma.org.uk
it is located in another area of the
house (e.g. upstairs), you might
find a commode helpful. These can
be positioned around the house
and can help prevent accidents.
Other toilet and bathroom aids are
14 www.myeloma.org.ukOther information available from Myeloma UK
Myeloma UK has a range of publications available covering all aspects of
myeloma, its treatment and management.
To order your free copies or to talk to one of our Myeloma Information
Specialists about any aspect of Myeloma, call our Myeloma Infoline on
0800 980 3332 or 1800 937 773 from Ireland.
The Infoline is open from Monday to Friday, 9am to 5pm and is free to phone
from anywhere in the UK and Ireland.
Information and support about myeloma is also available around the clock at
www.myeloma.org.uk
Published by: Myeloma UK
Publication date: May 2018
Last updated: July 2018
Review date: July 2021
Infoline: 0800 980 3332 15Myeloma UK 22 Logie Mill, Beaverbank Business Park, Edinburgh EH7 4HG T: 0131 557 3332 E: myelomauk@myeloma.org.uk Charity No: SC 026116 Myeloma Infoline: 0800 980 3332 or 1800 937 773 from Ireland www.myeloma.org.uk Myeloma Awareness Week 21 - 27 June
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