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Some people with multiple myeloma experience gastrointestinal (GI) issues, leading to symptoms like diarrhea, cramping, and constipation. Both the disease itself and its treatments can affect the digestive system, disrupting how the body processes food and water, which can contribute to these issues.
“I deal with severe constipation all the time,” one MyMyelomaTeam member wrote. Another said, “I’m very fatigued and have diarrhea.”
These bowel issues may be due to several factors, including myeloma symptoms, treatments, other health issues, or a combination of these factors.
Read on to learn about the various causes of bowel problems in multiple myeloma, as well as how they may be treated and managed. Talk to your oncologist or health care team if you experience new or worsened GI symptoms.
Bowel problems in multiple myeloma can come from the disease itself, common treatments for multiple myeloma, or other conditions that often occur alongside it.
Multiple myeloma can lead to high calcium levels in the blood, a condition known as hypercalcemia. This happens when the disease causes bone tissue to break down. Hypercalcemia can make it harder for your bowels to release stool, causing constipation.
Excess calcium also forces the kidneys to work harder to flush the mineral out of your system, which often requires more water. As a result, your bowels have less water available, which can lead to hard stools and constipation. However, hypercalcemia can also cause diarrhea in some cases.
Amyloidosis happens when proteins build up in your organs. This can cause damage and interfere with their normal function. This condition often happens alongside multiple myeloma and can cause symptoms like clay-colored stools, diarrhea, and other digestive problems.
Bowel problems can also be a side effect of multiple myeloma treatment. For example, constipation, diarrhea, and nausea are all common side effects of chemotherapy. As one MyMyelomaTeam member shared, “I’m on Pomalyst (pomalidomide) and dexamethasone … constipated.”
It can be difficult for doctors to distinguish between chemotherapy-induced constipation and constipation caused by other medications. Drugs used to manage other chemotherapy or cancer-related symptoms — including morphine (Astramorph), dexamethasone, and other corticosteroids — can also cause constipation.
Dialysis, a treatment used to filter waste from the body in people with kidney damage or kidney failure as a result of myeloma, can also lead to constipation in some cases.
Side effects like constipation may improve as your body adjusts to treatments like chemotherapy. Most side effects, including constipation, typically subside when treatment ends.
A cancer diagnosis can have a strong effect on your emotional well-being. Studies show that up to 40 percent of people with cancer experience undiagnosed psychological effects like depression and anxiety.
Stress, anxiety, and depression related to multiple myeloma can also cause or worsen digestive issues like constipation and diarrhea. When you’re under stress, your body produces chemicals that speed up the digestive process and reduce fluid absorption in your bowels. This can cause watery stools.
Being diagnosed with multiple myeloma or dealing with cancer treatment can change your eating, drinking, and exercise habits. These changes, such as eating differently, being less active, and not drinking enough fluids, can all lead to constipation, even without chemotherapy.
More than 790 members of MyMyelomaTeam have reported experiencing diarrhea or loose, watery stools. Diarrhea can be caused by amyloidosis, which sometimes occurs with multiple myeloma. It can also be a side effect of multiple myeloma treatment. Diarrhea from amyloidosis may be clay-colored or come with other digestive symptoms.
Diarrhea is one of the most common and difficult symptoms to manage during chemotherapy for multiple myeloma. It can be so severe that it may cause changes or delays in treatment.
Diarrhea is a common side effect of the chemotherapy drug lenolidamide (Revlimid). Research suggests that Revlimid may cause bile acid malabsorption (BAM), meaning that your small intestines can’t absorb bile salts properly. The extra salts cause your colon to release more water, which leads to watery stools as a side effect.
Unlike other chemotherapy drugs that cause short-term diarrhea as a side effect, Revlimid often causes late-onset diarrhea. This means it may show up 17 to 24 months after you start chemotherapy.
Some members of MyMyelomaTeam report experiencing diarrhea while undergoing chemotherapy with Revlimid. One member shared, “I was in hospital for eight days due to side effects of Revlimid. Got dehydrated, couldn’t eat, and had diarrhea.” Another said, “I had never-ending diarrhea from Revlimid. So much so, that when it was deemed to be a continued response, my oncologist discontinued it.”
If you’re concerned about diarrhea from multiple myeloma or your cancer treatment, talk to your doctor right away. They can offer suggestions on managing diarrhea and other GI symptoms or side effects.
Always talk to your oncologist before taking any medications to manage symptoms or side effects, including over-the-counter medications. Also, ask your doctor before making any changes to your diet to avoid negative interactions with your treatment.
You may be able to manage diarrhea with the following strategies.
If diarrhea is severe, your doctor might lower your dose of chemotherapy or stop the drug causing the issue.
Bile acid sequestrants (BAS) are medications that help lower cholesterol. BAS work by stopping bile acid in your stomach from being absorbed into your blood. Some studies suggest that BAS might help with diarrhea from BAM, but more research is needed to confirm this.
Mindful diet and nutrition changes may help improve diarrhea for those with multiple myeloma. Your doctor might recommend eating less fat or eating smaller meals and snacks throughout the day. Foods rich in sodium (salt) and potassium can help you replace the nutrients you lost during diarrhea.
Here are some foods that may help with diarrhea:
Some MyMyelomaTeam members keep a food diary to track which foods affect their GI symptoms. One MyMyelomaTeam member shared, “I’ve been having diarrhea these last few days. A month ago I was fine. I had a colonoscopy — all was good. I decided to keep a diary of my food.”
Diarrhea causes your body to lose fluids, which can lead to dehydration. If you have diarrhea, try to drink at least 8 to 12 cups of room-temperature water or other hydrating drinks every day.
After a bout of diarrhea, drinking clear liquids like water and broth can help replace lost fluids and give your bowels time to rest.
Both over-the-counter and prescription medications may help manage diarrhea related to multiple myeloma or chemotherapy. Only take medications as directed by your doctor.
Several members of MyMyelomaTeam have shared their experiences with medications to improve diarrhea. Some members have had positive experiences with medications like loperamide (Imodium). One member shared, “My husband takes half an Imodium and one packet of cholestyramine, split into two doses. It does help him.” Cholestyramine (sold as Prevalite, Questran Light, and Cholestyramine Light) is a BAS.
Another member of MyMyelomaTeam said, “I found out by accident that Pepto-Bismol actually stopped the diarrhea. I no longer need the prescription or Imodium.”
Constipation can affect different people in many ways. Some may feel mild discomfort, while others may experience severe abdominal pain and cramping.
Many MyMyelomaTeam members report other symptoms along with constipation. One member wrote, “My husband had his first zoledronic acid (Zometa) infusion on Friday. It caused him to feel weak, have unbelievable chills, and be extremely tired and constipated.” Another member shared that their GI symptoms fluctuate: “If I’m not constipated, I’m nauseous with diarrhea.” Many members also report loss of appetite.
If you experience severe or long-term GI symptoms like constipation, contact your health care team as soon as possible.
Talk to your doctor if you experience new or worsened symptoms of multiple myeloma, including constipation. Always get your doctor’s approval before trying any constipation treatments, even over-the-counter drugs. Some food and drinks can also affect your medications. Your doctor can help make sure they will not interact with your treatments or make your constipation worse.
Dehydration can cause constipation or make it worse. Be sure to drink plenty of liquids every day. Avoid foods or drinks that could dehydrate you. As one MyMyelomaTeam member advised, “Staying hydrated is key if you are allowed to drink as much as you can, especially during chemo and the days following. If you are fluid-restricted like me, drink as much as you are allowed.”
If you’re struggling with constipation, try drinking prune juice or warm liquids in the morning. Another MyMyelomaTeam member shared their method: “I had an awful problem with constipation for the longest time. This worked for me: a small glass of warm prune juice in the morning, followed by two prunes at a time, three times a day with a glass of water.”
Constipation and bowel obstruction make it harder for you to pass stool and may lead to bloating. Eating foods rich in fiber, such as prunes, may help with these problems. There are two main types of fiber: soluble and insoluble. They are classified according to how they react to water. You should aim to consume both types to help ease constipation.
Foods with this type of fiber become sticky and gooey when wet and easily dissolve in water. This helps slow down the stool’s movement through your bowel, which can help prevent discomfort. Some foods high in soluble fiber include:
Insoluble fiber doesn’t dissolve in water. Instead, it holds on to water, which helps form bulkier and softer stools, making it easier to pass. Insoluble fiber can also help regulate your bowel movements. Foods high in insoluble fiber include:
When eating fiber-rich foods, be careful not to overdo it. Too much fiber can cause abdominal pain or diarrhea. Instead, start slow and gradually increase your fiber intake by adding fruits, vegetables, beans, legumes, and whole grains.
When done correctly, some exercises can help speed up your bowel movement. One helpful exercise is bicycle pedals. To do this exercise, lie on your back and raise your knees to a 90-degree angle. Then, “pedal” your legs in the air as if riding a bike. Try to do this for at least 15 seconds at a time, repeating five times. If you feel too weak, go slow, or ask a caregiver or loved one to help you.
Hot or cold compresses don’t directly fix constipation, but they can help relieve pain and discomfort from severe constipation.
Massaging your stomach can help relieve constipation by encouraging your stomach and your bowels to move waste more quickly.
Before using over-the-counter laxatives or other remedies, talk to your doctor. They know your medical history and your current condition, so they can guide you on the safest and most effective way to manage your constipation.
Abdominal pain is a common symptom of hypercalcemia, which is linked to multiple myeloma. Painful stomach cramps and bloating can also happen due to BAM. BAM is linked to some chemotherapy drugs, including Revlimid.
More than 170 MyMyelomaTeam members have experienced abdominal pain and bloating from myeloma complications and treatments. One member talked about bloating from corticosteroids, which can be used alone or with other drugs to treat multiple myeloma. They said, “The only drug that gives me grief are the steroids with bloating, gas and constipation.”
Abdominal pain may happen on its own or with other GI symptoms, like constipation, weight loss, or nausea, with multiple myeloma. Another MyMyelomaTeam member shared, “I had a bad reaction to Revlimid. Abdominal bloating, gas pains, and nausea. Doc took me off all meds for one week to let my system stabilize.”
If you’re dealing with abdominal bloating or pain, it’s important to talk to your doctor, especially if it affects your quality of life. They can suggest treatments to help manage your symptoms, which may be similar to those for constipation or diarrhea.
Diet changes and adjustments to your treatment plan can help reduce abdominal discomfort. Staying hydrated is always important while you’re undergoing treatment for multiple myeloma. If conditions like depression or anxiety are contributing to your abdominal pain, your provider might recommend treatments for those as well.
Never stop or adjust medications on your own. Always consult your health care provider before making any changes.
MyMyelomaTeam is the social network for people with myeloma and their loved ones. Here, a growing community of more than 26,000 members comes together to ask questions, offer advice and support, and meet others who understand life with myeloma.
Have you experienced bowel problems like diarrhea or constipation with multiple myeloma? What has helped manage it? Share your thoughts and tips in the comments below or start a conversation by posting on your Activities page.
Leonora Valdez Rojas, M.D.
received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute.
Learn more about her here.
Joanne Zamora
is a pharmacist with nearly a decade of clinical experience in a tertiary hospital setting.
Learn more about her here.
Emily Van Devender
is a freelance health writer based in Portland, Oregon.
Learn more about her here.
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once I was diagnosed with MM my bowels almost instant reaction to cashews changed from a runny oily mess to softening the constipation MM began to produce. I've forgotten the name of the oily… read more
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