Looking after my body

Bladder and bowel problems

You may experience some bladder and bowel problems because of your illness, medication or treatment. These problems can be distressing, but there are things that you can do to manage them.

Bladder and bowel problems

You may experience some bladder and bowel problems because of your illness, medication or treatment. These problems can be distressing, but there are things that you can do to manage them.

Constipation

Constipation is when you’re not able to pass a stool and it becomes stuck in your bowel. It can be very uncomfortable and cause other problems.

Managing constipation

There are a number of things you can do to try to avoid or relieve constipation:

  • Make sure you drink enough fluid – six to eight cups (two litres) every day if possible.
  • Have a warm drink first thing in the morning but try to avoid having too many drinks containing caffeine.
  • Avoid alcohol.
  • Increase the amount of fibre you eat – try eating a high fibre cereal and wholemeal bread, prunes or prune juice, plums or rhubarb (unless you have been advised to follow a low fibre diet)
  • Eat more fruit and vegetables – fruit cake, digestive or bran biscuits might also help.
  • Keep as active as possible.
  • Try to develop a regular routine and give your bowels time to work.
  • Go to the toilet when you feel the urge. Don’t ignore the urge to go as this can make your constipation worse.

It may not always be appropriate to increase the amount of fibre in your diet, for example if your appetite is poor or you aren’t drinking enough. Check with your nurse or doctor.

You should talk to your nurse or doctor if you:

  • have persistent constipation, for example for more than four days
  • have pain in your stomach or bottom
  • feel or have been sick
  • experience bleeding from your bottom
  • pass a watery stool after having constipation

They can assess whether there’s a particular cause, decide if you need any medical treatment and give you advice.

Bowel obstruction

Some people with terminal illness can experience bowel obstruction. This occurs when the intestine is partly or completely blocked. There are a number of causes including:

  • illness, like bowel, gynaecological or abdominal cancers or kidney disease
  • infections
  • complications of surgery
  • hernias

For example, for bowel obstruction can affect people with cancer t when cancer cells stick onto the lining of the bowel wall. This makes it thicker and stiffer so it doesn’t stretch and push food along to the end the way it should. Or, if you have fluid collecting in your abdomen from a condition known as ascites, it can cause your bowel to work more slowly.

Sometimes it’s difficult for bulky food to pass through these narrow areas and it can get stuck. The bowel can then become swollen and full of liquid. Some food can get through, but it’s a bit changeable and this can lead to erratic bowel motions. This can cause constipation and diarrhoea. The blockage can also cause vomiting if the bowel starts to push the other way.

Common symptoms of bowel obstruction are:

  • feeling bloated all the time
  • a lot of gurgling noises from your abdomen area
  • feeling full after only a little food
  • constipation or a mix of constipation and diarrhoea
  • abdominal pain that comes in waves
  • nausea and sometimes vomiting foul smelling liquid
  • heartburn
  • not passing any flatulence (wind)

Bowel obstruction can be complex to manage. It’s important to seek advice from your nurse or doctor if you’re experiencing any of these symptoms. Treatment options can range from medications to surgery to diet restrictions.

Diarrhoea

Diarrhoea can mean either very loose, wet bowel motions, or more frequent bowel motions or a new pattern of incontinence. If you have diarrhoea you may also experience:

  • stomach cramps
  • needing to go to the toilet urgently
  • nausea or vomiting
  • headaches
  • loss of appetite

Causes of diarrhoea

There are many causes of diarrhea, including:

  • side effects of treatments
  • an infection
  • your illness itself
  • anxiety
  • your diet
  • food intolerances

Managing diarrhoea

Most cases of diarrhoea clear up within a few days without treatment, but if you have frequent diarrhoea, or if you see blood or pus in your faeces (poo), you should talk to your nurse or doctor who can advise whether you can take anti-diarrhoea medicine or painkillers, as well as exploring any other treatment that may be needed. You might need to provide a stool sample.

Diarrhoea can make you dehydrated so you should make sure you drink plenty of fluids. Eat solid foods as soon as you feel able to. Start with small amounts and avoid fatty, spicy or heavy foods.

Overflow diarrhoea

Severe constipation can cause a blockage in your bowel. Because of this, the bowel begins to leak out watery stools around the blockage from higher up in the bowel.

The leak from the bowel can look like diarrhoea . It’s called ‘overflow diarrhoea’. In this situation you shouldn’t take anti-diarrhoea medicines.

If you’ve had severe constipation and then develop diarrhoea, you should talk to your doctor or nurse before taking any more medicine for digestive disorders.

Bladder problems

Some illnesses, like cancer and neurological conditions, previous gynaecological problems, and treatments can cause bladder problems. Some people may lose their ability to control their bladder or have difficulty in emptying their bladder. Other problems include:

  • needing to pee more often or not peeing very often (known as urinary retention)
  • leaking urine
  • blood in the urine
  • having a burning sensation when peeing

If you notice bladder changes you should speak to your nurse or doctor who can check if there’s a specific cause and they can recommend appropriate treatment for you.

If you haven’t passed urine within a 24 hour period, contact your doctor straight away.

Mouth care and mouth problems

When you’re ill, you become more likely to have mouth problems, like dryness, ulcers, infection, bleeding gums, too much saliva and altered taste. Treatments like chemotherapy and radiotherapy can also increase your risk of developing mouth problems.

Mouth pain or other mouth problems

Talk to your doctor or nurse if you have:

  • mouth pain
  • signs of redness
  • swelling
  • sores
  • white patches
  • bleeding
  • are unable to rinse your mouth
  • any other mouth problems

They can check if there’s a particular cause and may be able to prescribe medication it’s needed. If swallowing pills is difficult for you, you may be prescribed liquid or water-soluble painkillers. They can also advise you on liquid food supplements if it’s too painful for you to eat solid food.

Home dental visits

If you’re not able to get your dentist regularly you may be able to have a home dental visit. To find out more about the community dental care in your area, visit the:

Cleaning false teeth and dentures

Keep false teeth and dentures fresh and clean.

  • Clean false teeth as usual.
  • If you wear dentures or dental plates take them out and clean them at least once a day using a large toothbrush or denture brush.
  • Don’t use toothpaste on dentures, use soap and water instead or a special denture cleaner.
  • Soak dentures or plates overnight in water, or as directed, and rinse them with warm water after eating.

Dry lips

After brushing your teeth and rinsing, you might like to apply an oral gel, like Bonjela, or lip balm to moisturise your lips.

Brushing teeth

Brush your teeth twice a day for at least two minutes, using a small headed toothbrush and fluoride toothpaste.

Other tips:

  • A soft toothbrush is best if your mouth is sore.
  • An electric toothbrush can be very effective and may be less tiring to use.
  • You only need to use only a small amount of toothpaste.
  • After brushing, rinse your mouth thoroughly.
  • Change your toothbrush every three months.
  • Visit your dentist regularly, if you’re able to.

Rinsing your mouth

Rinse your mouth after brushing your teeth and up to three or four times a day.

  • You can rinse your mouth with fresh water, a saline solution (one teaspoon of salt in a pint of water) or use a mouth wash, as recommended by your doctor, dentist or nurse.
  • For sore mouths, rinsing with salt water followed by cold water can be helpful.
  • Don’t use a sodium bicarbonate rinse, which can cause problems if you are ill.

Keeping your mouth moist

Help keep your teeth and mouth moist and clean by chewing sugar free gum and drinking plenty of water.

Soothing a sore or dry mouth

If your mouth is sore or dry, these tips may help:

  • Have milky drinks rather than fruit juices.
  • Avoid alcohol and very hot drinks.
  • Take sips of water in between bites of food.
  • Relieve a dry mouth with ice cubes, frozen fruit, lemonade or tonic water.
  • Suck on an ice cube.
  • Soothe your mouth with cold foods and fluid like custard, yoghurt, ice cream, jelly, mousse or chilled soups.
  • Try softer foods like porridge, pasta with a sauce, egg dishes, fish in sauce and milky puddings.
  • Eat moist food, for example with gravy or sauces.
  • Avoid dry foods like biscuits, toast and crisps.
  • Avoid spicy foods like curries and pickles, and acidic foods like citrus fruits.
  • Avoid or minimise smoking.
  • Try using a straw or teaspoon to avoid fluids or liquids coming into contact with the sorest part of your mouth.
  • Spray your mouth with cold water, or use a pipette to drop a few drops into your mouth, to keep it moist if you don’t feel like drinking.
  • Try fresh pineapple or unsweetened tinned pineapple for cleaning the mouth and tongue. You can also make ice cubes made of pineapple juice to suck on.

Pressure ulcers (bed sores)

How to recognise pressure ulcers

As the skin breaks down, an ulcer or sore forms. This can become extremely painful, and may take a long time to heal if you’re constantly lying down.

You’re most likely to get pressure ulcers on parts of the body where there is not much fat, such as:

  • heels
  • knees
  • ankles
  • toes
  • base of the spine
  • spine
  • back of the head
  • elbows and shoulder blades

There are four categories of pressure ulcers:

  • Category one is superficial so the skin is unbroken. The skin looks discoloured – it’s red on people with white skin, and purple or blue on darker skins. An early warning sign of pressure ulcers is when you apply pressure to discoloured skin, it stays discoloured.
  • Category two looks more like a blister, with the outer surface of the skin broken.
  • Category three looks like a deep wound, with much more loss of skin and underlying tissue.
  • Category four is extremely painful and serious. The muscles and bone underneath the pressure ulcer can also become damaged. These sores are susceptible to life-threatening infections such as MRSA (methicillin-resistant staphylococcus aureus).
  • Pressure ulcers can usually be managed at home by a district nurse. If the area is infected, hospital treatment is essential. Usually, the damaged tissue is removed using a variety of methods. These include with surgical instruments, through cleansing and irrigation, ultrasound, or laser treatment. In most cases a local anaesthetic is given so the procedure is pain-free.

What causes pressure ulcers?

There are several factors that increase the risk of pressure ulcers:

  • Lack of mobility – lying or sitting in one position.
  • Friction from being moved or dragged on bedding, or from uncomfortable clothing.
  • Certain drugs including chemotherapy, steroids and anti-inflammatories.
  • Malnutrition or poor nutrition and dehydration.
  • Lying in wet bedding or clothes.
  • Type 1 and type 2 diabetes.
  • If you’re an older person (70+) and your skin has thinned, you’re also more at risk of developing pressure ulcers.

Preventing pressure ulcers

In hospital and hospices, nurses turn patients regularly to avoid them getting pressure ulcers. This can be as often as every 15 minutes or up to two hours.

To prevent pressure ulcers, you can do the following things:

  • Check your skin regularly, particularly in places where sores are most likely to appear or where your skin is thin.
  • Change position often, and if possible you should alternate between sitting in a chair and lying in bed.
  • Get up and walk around if you can ̶ this will improve your circulation, and help to keep your muscles strong.
  • Avoid lying in damp or wet clothes and bedding, as this can cause or aggravate pressure sores.
  • Make sure that bed sheets are smooth and not wrinkled as this can add to friction on the skin. Cotton sheets are more comfortable than synthetic ones.
  • Keep your skin clean and dry and don’t use too much skin cream. Avoid using talcum powder.
  • These preventative measures also apply when you’ve already developed pressure ulcers. You need to move regularly so that the sores aren’t made worse by being in one position for too long.

Healthy diet

It’s important to get a good balanced diet, to give your body the strength to heal and prevent pressure ulcers. Good nutrition makes the skin healthier, so if you’re eating normal meals, try to have plenty of protein ̶ like eggs, fish, cheese and meat ̶ as well as fresh fruit and vegetables.

  • If eating is difficult, ask your nurse about nutritional supplements. People taking nutritional supplements before and after operations develop fewer pressure ulcers.
  • Always ensure you have plenty of fresh water. Dehydration has been shown to increase the risk of pressure ulcers and can delay healing. Fresh chilled water is much more appealing than water that has been sitting in a jug for hours.

Care at home

It may not be as easy to be turned regularly if you’re being cared for at home. Your carer might not have the energy or strength. Your nurse will carry out a detailed assessment about pressure-relieving equipment and can advise you about pads, special cushions, mattresses, overlays and V-shaped pillows. These can all help to prevent sores or stop them getting worse:

  • An air mattress can be placed on top of your normal bed mattress to relieve pressure.
  • V-shaped pillows can relieve pressure on your back.
  • You may have to consider buying a new bed mattress, but discuss this with a health professional before making this investment. It’s also possible to get a hospital bed for your home.

Your Marie Curie Nurse or district nurse can advise you on all of these aids, and may be able to give or lend them to you. V-shaped pillows and air mattresses are also available at some supermarkets and department stores, or online, but ask your nurse about this first.

What can be done to treat pressure ulcers: information for carers

If the person you’re looking after has pressure ulcers, tell the nurse or doctor. They will advise you on the best ways to reduce discomfort and speed up healing.

  • Pressure ulcers should be protected with specially-designed dressings and bandages – speak to your nurse about these.
  • Paracetamol can relieve pain at early stages of pressure ulcers.
  • Your doctor can prescribe creams or ointments to speed up healing.
  • Nurses can show you how to take care when washing and drying parts of the body where there are pressure ulcers.
  • They can also show you how to gently exercise arms and legs, change someone’s position and check that they’re comfortable if they can’t move around.
  • Any exercise – even while sitting in a chair – is helpful to keep circulation moving and relieve pressure.
  • A certain type of honey is sometimes used to help heal a pressure ulcer that is an open wound – ask your nurse where to get this.
  • Not everyone who is bedridden for long periods of time gets pressure ulcers, but even if this happens rest assured there is plenty you can do to make yourself more comfortable and speed up healing. Your nurse will be able to support you with this.