Nutrition Advice: Pelvic Area

For patients receiving radiation therapy to the pelvic area.

Introduction and Brief Description

Radiation therapy to the pelvic region or to bones in the lower back/hip area can result in more frequent, loose stools. This condition can also progress to diarrhea (4+ stools daily) as your radiation therapy continues. If you are going to have a change in bowel habit, it usually does not occur until sometime after the first week of treatment. It is important to note, however, that while most do, some people receiving radiation treatment do not experience a change in their bowel habits. The following suggestions can be beneficial in managing this potential side effect of radiation therapy to the pelvic region.

Attention prostate cancer survivors: most prostate cancer survivors do not have significant problems with bowel irritation because of the use of localized radiation fields; however, it is always a prudent idea to abide by some of the preventive nutritional measures to increase comfort and decrease the likelihood of a problem.

Nutrition Suggestions

The side effect of more frequent, loose stools starts gradually, so you should be aware of any change in bowel habits, and report the change to your dietitian, nurse or doctor. The following are some nutrition suggestions to start at the beginning of treatment in an effort to minimize the possible effects of radiation to the bowel.

  1. Minimize or avoid the consumption of acidic foods, such as tomatoes, tomato products, vinegar, citrus fruits and fruit juices (orange, grapefruit and pineapple).
  2. Do not totally eliminate fiber from your diet before you have a change in bowel habits. If you do, you can unnecessarily cause constipation, especially if you were eating a healthy amount of fiber on a daily basis and you stop abruptly.
  1. Minimize or avoid the consumption of spicy foods. Examples of spices that are known to irritate the bowel include: chili powder, cayenne, jalapeno pepper, mustard, and black pepper. Preparing your own food from scratch makes it easier to control the amount and type of seasoning being used. If you do choose processed foods, be particularly careful with spicy soups, sauces, stews, fresh or frozen selections.

If you start having more frequent, loose stools…

  1. Notify your Dietitian, Nurse and Doctor.
  2. Consider consuming 4-5 smaller meals instead of 3 larger meals; this helps with digestion and reduces the stress on the stomach.
  3. Limit or avoid known gas-producing foods, such as carbonated beverages, cruciferous vegetables, like broccoli and cabbage, large servings of greens like spinach, corn and beans including garbanzo, kidney and black beans. Try simethicone –containing products (ex: Gas-X® or Phazyme®) to help control abdominal gas, in addition to avoiding foods known to cause abdominal gas.
  4. Avoid excessive roughage such as seeds, nuts, popcorn and coconut.
  5. Avoid greasy fatty foods as these are not nutritious and they complicate digestion and nutrient absorption.
  1. Decrease the amount of higher-fiber foods such as high-fiber cereal (those that have 5-10 grams per serving), whole grain bread with nuts and seeds, and fresh fruit and vegetables that have tough skins (ex: pears and baked potato with skin) and seeds (ex: raspberries and cucumbers).
  2. Limit or avoid caffeine-containing beverages because they can make the bowel move faster and they also can contribute to dehydration. Examples of this type of beverage include: caffeinated coffee and tea, colas and some additional sodas that have caffeine added such as Mountain Dew® , Surge® , and certain root beers and orange-flavored sodas.
  3. Consume plenty of non-caffeinated beverages and foods that are liquid at room temperature such as Jell-O® *, ice cream*, and Italian ices*.

Medications

  1. Try Metamucil® , Citracel® , or any other psyllium fiber containing products to help absorb some of the fluid in the stomach, and to help form stools. Tolerance of these products is individual, but they are safe to use daily.
  2. Ask your nurse or doctor if Imodium AD® would help. They will give suggestions for use and dosage to manage frequent loose stools during this treatment.
  1. Add Pedialyte® /Pedialyte Pops® or other specialized water products with added electrolytes such as diluted Gatorade® to your daily fluid intake if you start to have a significant number of stools each day. This will help avoid dehydration and electrolyte imbalances that can result from diarrhea.

The following foods are bland, contain little fiber and are easier to digest when experiencing diarrhea

  • Smooth peanut butter
  • White rice
  • Applesauce
  • Lean beef or pork
  • Pasta
  • Ripe bananas
  • Fish
  • White bread
  • White grape juice**
  • Skinless poultry
  • Hot and cold cereal
  • Cranberry juice**

Commercially prepared liquids** such as those made by Ross Labs (Enlive), Novartis (Boost Breeze/Resource Fruit Drink) and Carnation Instant Breakfast (added to low-fat Lactaid missing trademark milk) can be very effective and easy ways to get extra nutrition.

* Please do not disregard previously defined dietary restrictions for heart disease, diabetes, or any other condition unless discussed with your dietitian, nurse, or doctor.

**Food and beverages that contain more sugar or natural sweetener should be limited and/or diluted.

For any additional questions or needed information, please call your registered oncology dietitians, Kathryn Hamilton or Mary-Giselle Ulbrich at 973-971-6232