Management of diarrhoea in palliative care

If diarrhoea is suspected in a patient with palliative care needs, confirm carefully; exclude overflow diarrhoea by clinical and rectal examination, and, if appropriate, abdominal X-ray. Management of diarrhoea depends on the cause, and is guided by the potential benefits and burdens of treatment and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

Use good-quality toilet paper or moist wipes for cleaning the perianal area, and use a barrier cream (eg Comfeel Barrier Cream, Sudocrem, zinc and castor oil cream) perianally to prevent perianal excoriation.

To slow bowel peristalsis in patients with palliative care needs who have diarrhoea, use:

For patient with high-output diarrhoea (eg carcinoid syndrome), psyllium powder may help improve continence and make the diarrhoea manageable. Use:

Octreotide may be used to minimise bowel secretions in a patient with severe diarrhoea (eg carcinoid syndrome, radiation-induced colitis)—seek specialist advice.

For management of diarrhoea caused by Clostridioides difficile, see the Antibiotic guidelines.

Diarrhoea caused by malabsorption (commonly from pancreatic cancer or resection) or high-calorie feeds may respond to oral pancreatic enzyme supplementation. A suitable initial regimen is:

Adjust the dose of pancreatic enzymes according to symptoms and maintain at the lowest effective dose in accordance with advice from a dietitian or specialist.

Haemorrhoids and anal fissures can occur commonly in patients with palliative care needs, see Haemorrhoids and Anal fissure in the Gastrointestinal guidelines for management.