Healthy Bowel Habits
Everyone has different bowel habits. The range for normalcy can range anywhere from three bowel motions per day to three per week. Many factors can affect regularity from day to day, such as diet, hydration, travel, medications, hormonal fluctuations, sleep, exercise, illness, surgery, stress, and more.
Pancreatic insufficiency in individuals with CF can cause loose, pale, oily, bad smelling stools, if pancreatic enzymes are not taken correctly. Good enzyme compliance should help to minimise these symptoms. It is important to keep an eye out for any changes in your bowel habits, which might signal a problem.
Sometimes it can be difficult to talk about bowel habits, particularly when having to describe them. A useful tool for this can be the Bristol stool chart, which provides a reference framework for assessing gastrointestinal (GI) symptoms and stool form.
Diarrhoea
People with CF will often experience diarrhea at one time or another. If you experience diarrhoea regularly, it may suggest that you are not digesting and absorbing the valuable nutrients and calories from your food which the body needs for maintenance and growth. Diarrhoea may result from not having enough enzymes, viral or bacterial infections or antibiotic use. A combination of dietary changes, compliance with enzymes, and increased fluid can often help regulate bowel motions.
Constipation
Constipation is the passing of hard, dry bowel movements. Stools may be hard to pass and can cause pain, bloating, discomfort and bowel obstruction or blockage. Constipation may result from having too many enzymes. Treatment of constipation may include increasing dietary fibre, salt and fluid intake as well as light exercise. Speak to your dietitian if this occurs regularly as they may be able to prescribe some laxatives and discuss other options.
DIOS
Distal Intestinal Obstruction Syndrome (DIOS) is a known complication of CF. It occurs when the small intestine gets partially or completely blocked with faecal material. Symptoms can include, abdominal pain, bloating, hard stools, a reduced amount of bowel movements, loss of appetite and vomiting.
Whilst symptoms can be similar to constipation, they are separate conditions, with DIOS having the potential for resulting in more serious implications such as surgery. Sometimes a hard mass can be felt on the right side of the abdomen. DIOS needs to be diagnosed with an abdominal x-ray.
It often occurs with a change in diet, illness, exacerbation and/or dehydration in hot weather. Having one episode of DIOS increases your risk for another and you may be prescribed laxatives or stool softening medications by your CF care team. If you have previously experienced DIOS, it can be really helpful to learn to recognise and treat symptoms early to prevent another episode.
To prevent constipation and DIOS, it is important to:
- Make sure that you take your enzymes, and that they are correctly matched to your fat intake.
- Ensure adequate fluid intake to prevent dehydration (8–10 glasses of water/day).
- Ensure adequate salt intake and replacement, particularly in warm weather.
- Include adequate fibre in your diet.
If you are experiencing irregular bowel habits, or symptoms of constipation or DIOS, it is important to speak with your CF care team.