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 the 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.
- 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 effect 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 effective, but the effectiveness varies 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 stool softeners and/or laxatives. Stool softeners (such as docusate sodium or Colace) work by bringing water into the stool, making it softer and easier to pass. A stimulant or laxative (such as Bisacodyl, Dulcolax, or Senakot) works by stimulating peristalsis, moving the stool through the bowel. For occasional or difficult to manage constipation your doctor or nurse may recommend Miralax (Polyethylene glycol 3350). Miralax is a different type of laxative called an osmotic laxative. It works by causing water to be retained in the stool, softening the stool so it is easier to pass. These medications can be taken together. There are even some preparations combining stool softeners and laxatives in one pill, such as Senakot-S.
If you have persistent problems with constipation, consider taking softeners and/or a stimulant every day, per the package dosing instructions. 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 regimen. If you have any questions about constipation or need additional information, ask your doctor or nurse.