Constipation

What is constipation?

Constipation is a decrease in the number of daily bowel movements and/or having a hard time passing stool. It may cause discomfort or bleeding from the rectum. 

Constipation may be caused by:

• Decreased fluid and/or food intake.
• Decreased activity.
• Some medications.
• Cancer treatments (chemotherapy).
• Cancers of the digestive system.

The signs and symptoms of constipation are:

• Small, hard bowel movements.
• No regular bowel movement in 3 days.
• Leaking small amounts of soft or liquid stool from the rectum.
• Stomachaches or cramps that happen often and don’t get better.
• Passing large amounts of gas or frequent belching.
• Swollen/enlarged belly.
• Nausea and/or vomiting.

When should I call my provider?

You should call your provider at the first signs of a problem so that your constipation can be fixed more easily and quickly.  Treating constipation early will lessen the chance of complications.

Call your team if you have any of the following:

• No bowel movement in 3 days.
• Blood in the stool or on the toilet tissue.
• Rectal pain.
• No bowel movement within 1 day of taking a laxative prescribed by your provider.
• Nausea/vomiting.
• Abdominal (belly) pain, cramping, or swelling.

What can I do?

• The cause of constipation in patients getting cancer treatment can often be related to medications, dehydration, or the tumor itself. Talk with your care team about the cause, as this can affect how it is best fixed.
• Increasing fiber (including Metamucil) in the diet is often not effective if your constipation is caused by pain medication. In those cases, you should take a laxative after speaking to your healthcare provider about which one is right for you.
• Drink 6-8 glasses of fluid per day. Try warm or hot fluids, especially in the morning.
• Increase your physical activity as much as possible. Even short walks will help decrease constipation.
• Try to have a bowel movement at a regular time each day, preferably after breakfast.
• Prune, apple, peach, and pear nectars/juices may be helpful as they have a laxative effect, but how they work varies from person to person and they may cause diarrhea.

How is constipation treated?

Treatment of constipation depends on its cause. Your provider may recommend a bowel regimen using fiber and/or laxatives.

• A fiber supplement may be helpful to relieve constipation that is not caused by pain medications. This is often the first treatment tried.
• Polyethylene glycol 3350 (Miralax) is an osmotic laxative. It works by causing stool to retain, or hold on to water. This makes the stool softer so it is easier to pass. It can be used to relieve constipation or taken regularly to help chronic constipation.
• A stimulant laxative (such as Bisacodyl, Dulcolax, or Senakot) works by stimulating peristalsis, moving the stool through the bowel. These should only be used for a few days. 
• You may need to combine these medications to find what works best for you. Your care team can help you make a plan. 

Do not use enemas unless told to do so by your care team. If you do not have a bowel movement in 3 or more days, talk with your provider about a stronger medication. If you have any questions about constipation or need more information, ask your provider.