Gastrointestinal Problems

Novel therapies used to treat multiple myeloma may be associated with gastrointestinal problems (e.g., nausea, vomiting, diarrhea, and constipation). Do not stop or adjust medications without discussing it with your healthcare provider. He or she may change your dose or schedule of medication to help reduce your discomfort.

What Helps Nausea?

Nausea is an unpleasant feeling in the throat and stomach.

• If you experience general nausea, eat small, frequent meals. Do not eat fatty or fried foods. Avoid strong odors. Do not exercise after eating. Wear loose clothing. Begin appropriate anti-nausea medications before chemotherapy. Use relaxation, acupuncture, biofeedback, and/or guided imagery. Take anti-nausea medications that may be ordered.
• If you experience a loss of appetite, but you are still able to eat normally, adjust dosages of medications, drink enough water and other fluids, and keep track of medications in a daily diary.
• If you experience a decreased ability to eat or drink, see your physician for a physical examination and evaluation.
• If you are unable to eat or drink, call a physician immediately. You may need hospitalization or medications.

What Helps Vomiting?

• Vomiting is a forceful emptying of the stomach’s contents.
• For vomiting, your healthcare provider may prescribe Aprepitant, Ondansetron, or Granisetron.
• For one episode of vomiting, continue medications for nausea as prescribed.
• For two to five episodes of vomiting in 24 hours, contact your physician immediately. New medications, oral or through the vein, may be needed.
• For six or more episodes of vomiting in 24 hours, contact your physician immediately. Hospitalization may be required to assess fluid status and to rule out bowel obstruction.

What Helps Constipation?

Constipation is a decreased frequency of defecation accompanied by discomfort and difficulty.

• For constipation, your physician may prescribe Docusate, Senna, magnesium sulfate, magnesium citrate, Lactulose, or Bisacodyl.
• For mild constipation, increase your fluid and fiber intake, increase your physical activity, and start stool softeners.
• For moderate constipation, speak with a dietician about your food intake and consider laxatives and stimulants.
• For severe constipation, your physician may discuss treatment for an impacted colon or assess if your bowel is obstructed. You may need medication changes or a referral to a gastrointestinal specialist. If you are concurrently experiencing dehydration, you may need to have fluids administered.

What Helps Diarrhea?

Diarrhea is an abnormal increase in the frequency and the amount of fluid in the stool.

• For diarrhea, your healthcare provider may prescribe Imodium, diphenoxylate, or octreotide.
• For fewer than four stools a day, drink more liquids. Avoid caffeinated, carbonated, heavily sugared beverages. Dietary changes may be needed. Discontinue any medications that cause diarrhea. Keep the rectal area clean.
• For four to six stools a day, you may need medications as well as fluids and salts.
• If you have more than six stools per day for more than 24 hours, you should notify a physician. A stool culture will be ordered to see whether diarrhea is the result of an infection. Hospitalization may be considered for fluid replacement. Take very good care of your skin and use disposable pads or diapers. Cancer therapy may be stopped or the dose may be lowered.