Bowel Regularity During Chemotherapy

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Q: My husband was diagnosed with multiple myeloma. He is eating mostly soups (vegetable soups with chicken/pork/beef). He has just finished the first cycle on the new chemotherapy regimen and once-a-month Zometa. He is constipated [and] gassy most of the time. When he moves his bowels, it is a few round hard stools. Sometimes after that he has diarrhea. There is no in between. How can we address this problem?

K.O., Potomac, Maryland 

One way of managing constipation and diarrhea is to add soluble fiber to the diet. This fiber will help move food through the GI tract to battle constipation. Soluble fiber may also alleviate the diarrhea because it will help to form soft stools. Soluble fiber can be found in whole grain products like oat-based whole grain crackers, cereals and breads, oatmeal, beans and fresh or frozen fruits and vegetables.

You may want to try removing seeds and skins from fruits and vegetables and cooking vegetables to make them easier to swallow and digest.

If your husband has a hard time swallowing some of these foods, you may also want to try Benefiber. Benefiber is an over-the-counter supplement that provides soluble fiber to the diet to alleviate constipation. It is dissolvable in any liquid, hot or cold, and it is tasteless but can be bought in a variety of flavors.

Adequate water intake is very important in managing constipation and diarrhea. It will help alleviate constipation and it will replenish water loss that occurs during diarrhea. We recommend 8-10 glasses of water and fluids per day. With increased diarrhea, you may want to increase the liquid intake. For more tips on symptom management, read our "managing side effects" information.

To avoid muscle atrophy, your husband should be eating enough calories and protein. These calories will provide the body with energy so it does not have to break down muscle for energy.

Eating small, frequent meals will help his diarrhea and constipation, but if the meals are higher in calories, it will help him to avoid losing muscle mass.

Seeing that your husband is eating mostly soups, try higher calorie ones like split pea, tomato bisque or chili.

When increasing fluid intake, choose some high-calorie drinks, such as fruit juices, frappés, milk or commercially prepared supplements like Ensure.

Just beware of foods very high in fats, such as fried food, as this may increase diarrhea.

To restore some muscle loss, higher protein foods, such as meats, poultry, eggs, and fish, would also be a good addition to your husband's diet.

For exercise to restore muscle loss, walking would be the best choice. It will keep his muscles active but not put too much strain on them.

Also, because your husband is on Zometa, we recommend talking to his doctor about checking his vitamin D level. If he finds that his vitamin D is low, he may require a supplement.

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