Survivorship 2: Normal and Abnormal Bowel Function in Cancer Survivors

Course Overview

About 10-15% of all cancer survivors experience problems with bowel function following treatment for cancer. Annette Bisanz, an Advanced Practice Nurse at The University of Texas MD Anderson Cancer Center, says abnormal bowel function can be embarrassing, uncomfortable, and painful and may even require a trip to the emergency room. Ms. Bisanz has served as an RN for 47 years, spending the last 30 at MD Anderson. She has treated more than 20,000 patients with bowel issues and is considered a world-wide authority on bowel management.

Cancre SurvivorsIn her first lecture, "Overview of Factors Influencing Bowel Function," Ms. Bisanz describes the roles that food, fluid, fiber, and medication play in bowel management. She specifically describes how fiber can be used to speed up or slow down the passage of food through the gastrointestinal tract. Ms. Bisanz discusses gas-producing foods – some of which, like soda and chewing gum, may be surprising – and gives advice on how to relieve gas symptoms. She also describes Ogilvie syndrome and how to treat it.

In her second lecture, Ms. Bisanz focuses on one of the more common side effects cancer survivors face, "Diarrhea and its Multiple Causes." She describes how to assess for multiple causes of diarrhea and why it's important to include all causative factors. Ms. Bisanz also discusses how to effectively use the Diarrhea Assessment and Treatment Tool.

In her third lecture, "Treating Diarrhea," Ms. Bisanz discusses the pharmacological treatment of diarrhea, including treatment plans for chemotherapy- and radiation treatment–associated diarrhea. Ms. Bisanz outlines specific steps for treating patients with secretory or exudative diarrhea, malabsorptive diarrhea, and dysmotility diarrhea following surgical intervention. She also describes a bowel management system and offers advice on how to determine when its use is warranted.

In her fourth lecture, "Normal Bowel Function and Dysfunction Related to Constipation and its Treatment," Ms. Bisanz describes what normal bowel function is and why patient education is important: up to 78% of cancer survivors report being constipated. She gives three clinical examples of constipation and discusses two types of impaction. Ms. Bisanz also describes how to perform digital stimulation and counsels on how to effectively normalize the constipated bowel and select and effectively utilize a successful bowel maintenance program.
     Course Overview: Español


Annette Bisanz, MPH, BS, RN
Presenter: Annette Bisanz, MPH, BS, RN
Advanced Practice Nurse
Nursing Administration

Overview of Factors Influencing Bowel Function
Summary: Many cancer survivors report having some type of bowel issue after treatment of their cancer has ended. Annette Bisanz, Advanced Practice Nurse at The University of Texas MD Anderson Cancer Center, says that it takes a lot more than eating probiotic yogurt every day to get the bowel moving normally again. In this lecture titled "Overview of Factors Influencing Bowel Function," Bisanz says that food, fiber, fluid, and medication all play a role and that teaching a patient how these all work together is the key to better bowel function. The lecture begins with an overview of how food, fluid, and fiber affect the gastrointestinal tract. Next, Bisanz discusses why advertisements for medicinal fiber can be confusing. She sorts out how much powdered fiber should be taken and how often. She also briefly discusses the causes of diarrhea and constipation.

Diarrhea and its Multiple Causes
Summary: People with cancer can experience diarrhea. But not all diarrhea is the same, according to Annette Bisanz, Advanced Practice Nurse at The University of Texas MD Anderson Cancer Center. In this lecture titled "Diarrhea and Its Multiple Causes," Bisanz begins by explaining the clinical definition of diarrhea and why assessing the causes contributing to diarrhea is so important. She then describes the different classifications of diarrhea and how using the Diarrhea Assessment and Treatment Tool can be beneficial.

Treating Diarrhea
Summary: Treating diarrhea is not a one-step process. Annette Bisanz, Advanced Practice Nurse at The University of Texas MD Anderson Cancer Center, presents this lecture titled "Treating Diarrhea." Bisanz begins by explaining why healthcare professionals must treat all of the causes of diarrhea, not just the symptoms. She also discusses problems with diarrhea management and why diarrhea is often undertreated. In addition, Bisanz takes an in-depth look at several types of antidiarrheal agents and how they should be used. She ends the presentation by explaining how a bowel management device and exercises can help to treat some types of diarrhea.

Normal Bowel Function and Dysfunction Related to Constipation and its Treatment
Summary: More than 50% of cancer patients become constipated at some point in their treatment. Annette Bisanz, Advanced Practice Nurse at The University of Texas MD Anderson Cancer Center, says that healthcare professionals must never underestimate the amount of stool the bowel can hold. In this lecture titled "Normal Bowel Function and Dysfunction Related to Constipation and its Treatment," Bisanz offers three clinical cases to help healthcare providers better understand the effects of constipation. Bisanz explains the causes of constipation and how to determine what a patient's normal bowel function should be. She also explains how to go about normalizing bowel function before starting the patient on a bowel maintenance program. In addition, Bisanz describes several bowel training processes, including digital stimulation.



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