Chemo Care

Abdominal Pain/Cramping

What is abdominal pain and abdominal cramping? What is their relationship to cancer and chemotherapy treatments?

The abdomen is the part of the body located between the chest and the pelvis. Most people refer to it loosely at the stomach (although the stomach is an organ within the abdomen). Pain is a personal experience of discomfort. Abdominal pain can be associated with a variety of conditions both within and outside or the abdomen. Abdominal or lower abdominal pain can be a dull ache, cramping, or sharp pain. Dull aches and cramping are not uncommonly associated with some chemotherapy drugs. Sharp pain that does not resolve in a few minutes may be an indicator of a more serious problem.

Cancer treatment-induced abdominal pain, cramping and flatulence (gas):

• Chemotherapy can cause both increased (rapid) and decreased (slow) motility of the intestines. In other words, the normal wave-like action that moves stool through the bowel may be faster or slower than usual.
• Rapid motility may cause stool to travel faster and be less formed. Rapid motility can be associated with cramping and/or diarrhea.
• Slow motility may cause stool to travel slower, becoming harder and dryer and more difficult to pass. It may contribute to constipation. Pain may be achy or cramp-like and may be associated with increased flatulence (gas).
• Chemotherapy may also alter the normal bacterial flora that is present in the intestines. This can affect digestion and cause abdominal pain, cramping or flatulence (gas).
• Steroids and other immunosuppressive medications may increase the probability of ulcers or other potentially serious abdominal complications such as perforation.
• A history of or the development of lactose intolerance may contribute to worsening abdominal pain, cramping or flatulence (gas).
• Cramping is a caused by a spasm (or contraction) of the bowel. It may be associated with the urge to move your bowels. It is not usually constant but comes more in "waves". It may be accompanied by either diarrhea, constipation or flatulence (gas).

Things you can do to manage abdominal pain or cramping:

• In order for your health care provider to assist you in managing your pain, it is helpful for you to be able to adequately describe your pain. One way to do this is by answering the following questions.
• You may choose to keep a diary so that you can track your pain over time:
• Onset - when did the pain start? What was I doing when I had pain?
• Quality - what does the pain feel like? Is it knifelike and stabbing, or dull and constant?
• Location - Where is the pain? Can I point to it with my finger, or is it spread all over?
• Intensity - How bad is your abdominal pain all the time? How bad is it with certain activities that cause you to feel pain, on a 1-10 scale, with the number "10" being the worst pain imaginable?
• Duration - How long did the pain last for? Is it while I was walking to the door, or did it continue for a while?
• Character or aggravating factors - Does the pain come and go whenever I perform a certain activity, or is it unpredictable?
• Relieving factors - What can I do to make the abdominal pain go away? Does anything help? What have I used in the past that have worked, and does this work now?
• How is your mood? Are you depressed or anxious? Does this make the pain worse?
• Sometimes lying down for a while will help relieve abdominal discomfort.
• Drink plenty of fluids (2-3 quarts every 24 hours), unless you have been told to restrict your fluids.
• Take your medication with food unless you are specifically to take it on an empty stomach.
• Avoid aspirin or products containing aspirin and NSAIDs (non-steroidal anti-inflammatory drugs, unless your doctor specifically prescribes them.
• Avoid narcotic pain medications if they are not needed. Do not use for abdominal pain, unless recommended by your physician (the cause of the pain should be determined first).
• Avoid drinking alcohol and smoking cigarettes; both can be irritating to your stomach.
• If you experience cramping, you may try to relax and breathe deeply to assist in relief.
• Eat bland foods in small amounts: similar to managing nausea and/or diarrhea.

Nausea/Vomiting

Foods to avoid during cancer treatments, to avoid abdominal pain:

• Hot, spicy foods (i.e. hot pepper, curry, Cajun spice mix).
• Fatty, greasy or fried foods.
• Very sweet, sugary foods.
• Large meals.
• Foods with strong smells (foods that are warm tend to smell stronger).
• Eating or drinking quickly.
• Drinking beverages with meals.
• Lying down after a meal.

Tips to try:

• Small meals throughout the day.
• Refrigerated or room temperature entrees.
• Rinse mouth with lemon water after eating.
• Suck on ice cubes, mints, or hard candies.
• Distractions such as TV, music, or reading may be helpful while eating.

Diarrhea

Foods to avoid:

• Hot, spicy foods (i.e. hot pepper, curry, Cajun spice mix).
• High fiber foods (i.e. raw fruit and vegetables, coarse whole grains).
• Fatty, greasy, or fried foods.
• Rich desserts.
• Nuts, seeds, or dried fruit.

Beverages to avoid:

• Beverages that are very hot or cold.
• Beverages containing caffeine (coffee, strong tea, soda, and possibly chocolate).
• Use caution with milk products.

Tips to try to minimize or avoid cancer treatment-based abdominal pain:

• Low total fiber or good soluble fiber source (i.e. rice, bananas, white bread, oatmeal, mashed potatoes, applesauce, skinless/boneless chicken or turkey).
• Increase the amount of sodium (salt) and potassium in your diet.
• Drink plenty of fluids.

In some cases, managing your abdominal pain may require some "trial and error" in terms of identifying things that may make it better or worse.

Drugs or recommendations that your health care provider may prescribe:

• Although there are many over-the-counter remedies for abdominal pain, they are usually associated with other stomach problems as well. You should discuss taking any medications with your health care provider. Some medications include: Maalox®, Mylanta®, Pepto-Bismol®, and TUMS®.
• If you are lactose intolerant, Lactaid® may help.
• See also; Managing Heartburn, Managing Nausea, Managing Diarrhea or Managing Constipation, if applicable.

When to call your health care provider:

Seek emergency help and call your doctor immediately if you develop sudden severe abdominal pain that does not resolve in a few minutes, especially if accompanied by any of the following:

• Sudden abdominal swelling.
• Feeling faint, weak and dizzy.
• Sweating
• Fever of 100.5 or higher.
• Sudden vomiting or vomiting blood.
• Loss of consciousness.
• A stiff board-like abdomen

Contact your health care provider within 24 hours if you experience:

• Constant abdominal pain that does not go away with prescribed methods.
• Cramping that does not go away after trying options listed above.
• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period).
• Diarrhea (4-6 episodes in a 24-hour period).
• Black or tarry stools, or blood in your stools.
• If you have not had a bowel movement in three days despite following the recommendations of your doctor or health care professional.
• If your stomach looks swollen and/or feels hard to the touch.

Flatulence (Gas)

What is flatulence and how is it affected by cancer treatment?

Flatulence, or gas, is actually a normal bodily function and, in fact, it is quite healthy. Socially, flatulence is fairly unacceptable but the fact remains...we all have "gas." Flatulence is the by-product of digestion, although when cancer treatment causes severe flatulence and/or lower abdominal pain, measures can be taken to minimize the treatment's effects. All food that enters the body is digested (broken down) into small parts (nutrients) to be absorbed into the bloodstream through the bowel wall and transported to other parts of the body.

Protein must be broken into amino acids, fats must be broken into fatty acids and carbohydrates must be broken down into glucose-like molecules. Nutrients that are not used are stored as fats or glycogen.

Sometimes, food is not completely broken down in the stomach or small intestine. There are a variety of reasons why food does not break down in the stomach or small intestine including lactose intolerance (the body lacks the enzyme lactase to break down lactose), for example. Once the food arrives in the large intestine, there are hundreds of bacteria (normal flora) that are available to help break down break down the undigested food. When this happens, a variety of gasses are released (much like the carbon dioxide released by yeast when making bread rise). These bacteria release gases like methane, hydrogen, and hydrogen sulfide. Hydrogen sulfide is the gas that causes odor.

Certain foods are more difficult to digest than other foods. Carbohydrates are the most flatulence-producing foods. Some of these include beans, bran, potatoes, fruits, vegetables (such as cabbage, broccoli, and cauliflower, onions, garlic) and even milk.

On a lighter note, flatulence, in addition to being known as gas, has also been referred to as toots, farts, honks, breaking wind and a variety of other home-concocted names.

Chemotherapy-induced abdominal pain, cramping and flatulence:

• Chemotherapy can cause both increased (rapid) and decreased (slow) motility of the intestines. In other words, the normal wave-like action that moves stool through the bowel may be faster or slower than usual.
• Rapid motility may cause stool to travel faster and be less formed. Rapid motility can be associated with cramping and/or diarrhea.
• Slow motility may cause stool to travel slower, becoming harder and dryer and more difficult to pass. It may contribute to constipation and lower abdomen pain. Pain may be achy or cramp-like and may be associated with increased flatulence (gas).
• Chemotherapy may also alter the normal bacterial flora that is present in the intestines. This can affect digestion and cause aching, cramping or flatulence (gas).
• Steroids and other immunosuppressive medications may increase the probability of ulcers or other potentially serious abdominal complications such as perforation.
• A history of or the development of lactose intolerance may contribute to worsening abdominal pain, cramping or flatulence (gas).
• Cramping is a caused by a spasm (or contraction) of the bowel. It may be associated with the urge to move your bowels. It is not usually constant but comes more in "waves." It may be accompanied by either diarrhea, constipation or flatulence (gas).

Things you can do and cancer treatment-induced abdominal pain:

• Drink plenty of fluids (2-3 quarts every 24 hours), unless you have been told to restrict your fluids.
• Take your medication with food unless you are specifically to take it on an empty stomach.
• Avoid aspirin or products containing aspirin and NSAIDs (non-steroidal anti-inflammatory drugs, unless your doctor specifically prescribes them.
• Avoid narcotic pain medications if they are not needed. Do not use for abdominal pain.
• Avoid drinking alcohol and smoking cigarettes; both can be irritating to your stomach.
• If you are experience cramping, you may try to relax and breathe deeply to assist in relief.
• Eat bland foods in small amounts: Similar to managing nausea and/or diarrhea.

Nausea/Vomiting

Foods to avoid:

• Hot, spicy foods (i.e. hot pepper, curry, Cajun spice mix).
• Fatty, greasy or fried foods.
• Very sweet, sugary foods.
• Large meals.
• Foods with strong smells (foods that are warm tend to smell stronger).
• Eating or drinking quickly.
• Drinking beverages with meals.
• Lying down after a meal.

Tips for avoiding lower abdominal pain and flatulence while undergoing cancer treatments:

• Small meals throughout the day.
• Refrigerated or room temperature entrees.
• Rinse mouth with lemon water after eating.
• Suck on ice cubes, mints, or hard candies.
• Distractions such as TV, music, or reading may be helpful while eating.

Diarrhea

Foods to avoid:

• Hot, spicy foods (i.e. hot pepper, curry, Cajun spice mix).
• High fiber foods (i.e. raw fruit and vegetables, coarse whole grains).
• Fatty, greasy, or fried foods.
• Rich desserts.
• Nuts, seeds, or dried fruit.

Beverages to avoid:

• Beverages that are very hot or cold.
• Beverages containing caffeine (coffee, strong tea, soda, and possibly chocolate).
• Use caution with milk products.

Tips to try:

• Low total fiber or good soluble fiber source (i.e. rice, bananas, white bread, oatmeal, mashed potatoes, applesauce, skinless/boneless chicken or turkey).
• Increase the amount of sodium (salt) and potassium in your diet.
• Drink plenty of fluids.

Drugs or recommendations that your health care provider may prescribe to combat flatulence and abdominal pain during and after cancer treatment:

• There are over-the-counter remedies for flatulence. Most contain the ingredient simethicone. Some products include Gas-X® and Beano®. Also, some anti-acids contain simethicone. If you are lactose intolerant, Lactaid® may help. You should discuss taking any medications with your health care provider.

See also: Managing Heartburn, Managing Nausea, Managing Diarrhea or Managing Constipation, if applicable.

When to call your health care provider:

Contact your health care provider within 24 hours if you experience:

• Constant abdominal pain that does not go away with prescribed methods.
• Cramping that does not go away after trying options listed above.
• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period).
• Diarrhea (4-6 episodes in a 24-hour period).
• Black or tarry stools, or blood in your stools.
• If you have not had a bowel movement in three days despite following the recommendations of your doctor or health care professional.
• If your stomach looks swollen and/or feels hard to the touch.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.