Karen T. Bruchak, RN, MSN, MBA
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
What is Constipation? What can I do to prevent constipation? When should I call my doctor about my constipation? How is constipation treated?

Karen T. Bruchak, RN, MSN, MBA responds:

What is constipation?

Constipation refers to a decrease in the frequency of bowel movements and/or the difficult passage of hard stool, which often causes pain, discomfort and, sometimes, bleeding from the rectum. Constipation is caused by too little fluid and not enough movement in the bowel. In patients being treated for cancer, several factors may contribute to the development of constipation, including poor food and fluid intake, lack of activity, and general weakness. Certain medications, especially pain medications and certain chemotherapy drugs, may also cause constipation. And sometimes the cancer itself, especially cancers in the gastrointestinal tract, may cause constipation.

What Can I Do to Prevent Constipation?

Unlike many of the other side effects of cancer and its treatment, there are certain things that you yourself can do to prevent or minimize constipation. The actions to take include:

Know what to look for. The signs and symptoms of constipation include:

  • small, hard bowel movements
  • failure to have a regular bowel movement in 3 days
  • leaking of small amounts of soft stool (like diarrhea) from the rectum
  • frequent and/or persistent stomach aches or cramps
  • passing a large amount of gas or frequent belching
  • blown-up or enlarged belly nausea and/or vomiting
Increase the amount of high fiber foods in the daily diet,including:
  • fresh raw vegetables
  • fresh raw fruits, especially those with skins (apples, pears,plums) and seeds
  • bran, whole grains and cereals
  • dried fruits, especially dates, prunes and apricots
  • prune juice
Avoid or decrease the intake of foods that can cause constipation, including:
  • chocolate
  • cheese
  • eggs
Increase fluid intake. Try to drink about 3 quarts of fluid perday, unless your doctor or nurse tells you not to do so. Not only will this help toprevent or minimize constipation, but it will also help to prevent dehydration and malnutrition. Specific fluids to drink include:
  • fresh fruit juices, except apple juice
  • warm or hot fluids, especially in the morning
  • Increase physical activity as much as possible. Even short walks will helpdecrease constipation. It is important, however, that the level ofactivity does not cause severe tiredness or exhaustion.
  • DO NOT use over-the-counter laxatives, stool softeners or enemasunless instructed to do so by your doctor or nurse. If you have tried the measures described above and your are still constipated, discuss the situation with your doctor or nurse, who will give your further instructions.

When Should I Call My Doctor

Call your doctor immediately if you have any one or more of the following:
  • no bowel movement in 3 days
  • blood in or around the anal area, in the stool, on the toiletpaper or in the toiled bowel after a bowel movement
  • no bowel movement within 1 day of taking a laxative prescribed by the doctor
  • persistent, severe cramps in the lower abdomen and/or vomiting

How is Constipation Treated?

Prevention of constipation is always the best. If, however, specific actions on your part as described above are not successful, your doctor may order the following:
  • over-the-counter laxatives and/or stool softeners
  • enemas

Remember to check with your Doctor before you take any laxatives or stool softeners.Ask your Doctor or Nurse if you have any questions about constipation, or any other questions about your treatment.


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