Constipation

What is constipation?

Constipation is a decrease in the number of bowel movements you have. It can also mean you are having a hard time passing stool. It can cause belly pain, rectal pain, and bleeding from the rectum. 

Constipation may be caused by:

• Eating or drinking less than usual.
• Being less active.
• Some medications.
• Cancer treatments.
• Too much calcium in your blood (hypercalcemia).
• Scar tissue from surgery.
• Cancer itself.

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 a lot of gas or belching (burping) often.
• Swollen (distended) belly.
• Nausea and/or vomiting.
• Not feeling hungry.
• Confusion.
• The feeling that not all of your stool has passed.

When should I call my provider?

You should call your provider at the first signs of a problem so that your constipation can be treated. Treating constipation early will lessen the chance of other issues.

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?

• Constipation during cancer treatment can be caused by medications, dehydration (not drinking enough), or the tumor itself. Talk with your care team about the cause, as this can affect how it is treated.
• Increasing fiber (including Metamucil) in the diet does not often help if your constipation is caused by pain medication. In those cases, you should take a laxative after talking with 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 suggest a bowel regimen using fiber and/or laxatives.

• A fiber supplement may be helpful to help with constipation that is not caused by pain medications. This is often the first treatment.
• Polyethylene glycol 3350 (Miralax) is an osmotic laxative. It works by causing stool to retain (hold on to) water. This makes the stool softer, so it is easier to pass. It can be used as needed to relieve constipation or taken regularly to help chronic (longterm) constipation.
• A stimulant laxative (such as Bisacodyl, Dulcolax, or Senakot) works by stimulating (revving up) peristalsis (movement of your bowels), 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.