Causes of diarrhoea in palliative care

Diarrhoea is relatively uncommon in patients with palliative care needs. When it occurs, diarrhoea is more commonly caused by overflow from constipation or a partially obstructing intraluminal tumour (‘spurious diarrhoea’). Diagnosis of constipation as the reason for the diarrhoea is crucial, because management is different (see Management of constipation in palliative care).

Diarrhoea can arise from a secretory tumour, enteral fistulas or bowel infection. Clostridioides difficile (formerly known as Clostridium difficile) infection is not uncommon in palliative care, particularly in a patient who has had antibiotics or chemotherapy. Typically, the resulting faeces are semiformed and offensive, with high frequency; incontinence and urge are common.

Drug-related hypermotility from excessive laxatives or prokinetic drugs (eg metoclopramide, domperidone) can also cause diarrhoea. Diarrhoea is common with high-sugar or high-calorie dairy-based nasogastric or percutaneous endoscopic gastrostomy (PEG) feeds. Less common causes of diarrhoea include dumping syndromes, blind loop syndromes with bacterial overgrowth, lactose intolerance and malabsorption.