Constipation

Author: OncoLink Team
Last Reviewed: November 11, 2019

What is constipation?

Constipation is a decrease in the number of daily bowel movements and/or the difficult passage of hard 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), and/or cancers of the digestive system.

The signs and symptoms of constipation include:

  • Small, hard bowel movements.
  • No regular bowel movement in 3 days.
  • Leaking small amounts of soft or liquid stool from the rectum.
  • Frequent and/or persistent stomachaches or cramps.
  • Passing large amounts of gas or frequent belching.
  • Blown-up or enlarged belly.
  • Nausea and/or vomiting.

When should I call the doctor or nurse?

It is important to call at the first signs of any problem so that constipation can be managed more easily with the least amount of interventions and so that complications do not occur.

Call your team if you have any of the following:

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

What can I do?

  • The cause of constipation in patients undergoing 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 managed.
  • 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.
  • Attempt 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 the effectiveness varies from person to person and they may cause diarrhea.

How is constipation treated?

Treatment of constipation will depend on its cause. Your doctor or nurse 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 water to be retained in the stool, softening the stool so it is easier to pass. It can be used to relieve constipation or taken regularly to manage 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 instructed by your doctor or nurse. If you do not have a bowel movement in 3 or more days, talk with your doctor or nurse about a stronger medication. If you have any questions about constipation or need additional information, ask your doctor or nurse.

References

Paquette, I. M., Varma, M., Ternent, C., Melton-Meaux, G., Rafferty, J. F., Feingold, D., & Steele, S. R. (2016). The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the evaluation and management of constipation. Diseases of the Colon & Rectum59(6), 479-492.

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