Managing Constipation From Chemotherapy
Constipation is difficulty passing stools or a decrease in the number of stools. It may be accompanied by gas, abdominal cramping, or pressure in the lower abdomen. Constipation may lead to stool impaction, a severe form of constipation where the stool will no longer pass through the colon or rectum.1,2
Causes of Constipation
Constipation is caused by a slowing of the intestinal activity. The normal wave-like action of the intestines, called peristalsis, serves to continually move stools out of the body. When peristalsis slows, the stools become hard, dry, and difficult to pass.3
Constipation can have a number of causes, including:1,3
- Pain medications
- Chemotherapy drugs
- Decreased activity
- Poor diet
- Inadequate fluid intake
Chemotherapy drugs can cause either an increase or a decrease in peristalsis (your body's ability to push food through the gastrointestinal track). An increase in intestinal activity may cause stools to travel faster and be less formed, resulting in cramping or diarrhea. A decrease in intestinal activity may cause stools to travel more slowly, becoming hard and dry and more difficult to pass, which is constipation.3,4
Diagnosing Constipation
Symptoms of constipation include:4
- A sustained decrease in the frequency of bowel movements from
normal. There is actually no "normal" schedule for bowel movements;
everyone's schedule is different. If you normally move your bowels
once per day, a change in bowel movements may be every second
or third day.
- Hard, difficult-to-pass bowel movements you may pass small, marble-like pieces of stool without a satisfactory elimination.
- Cramping or flatulence (gas)
Preventing Constipation
It is easier to manage constipation with lifestyle changes than to treat it once it happens. Here are some tips:4,5
- Drink plenty of water. Fluids keep the stool soft. Try to drink six to eight (8 ounce) glasses of fluid a day.
- Eat foods high in fiber, such as fruit, vegetables, and beans. High-fiber foods stimulate the intestines to move.
- Avoid cheese, meat, processed food, and other low-fiber foods that cause constipation.
- If your doctor approves, exercise daily. Exercise helps stimulate
digestion and prevent constipation. Moderate activity such as
walking will help.
It may also help to keep track of your bowel movement schedule so you can learn which lifestyle measures work best for you. If you miss a bowel movement, try increasing your fluid intake or adjusting your diet. Call your doctor if your bowels have not moved in 2 days.1
Talk to your doctor about other ways to manage constipation.
Sometimes side effects signal a serious problem. Find out when to call your doctor about chemotherapy side effects.
Treating Constipation
If you have tried the above lifestyle changes and still experience constipation, your doctor may prescribe laxatives.1 Laxatives are available in liquid, tablet, gum, powder, and granule forms. There are several different kinds that work in different ways.
Laxatives should be used only for a short period of time in order to retrain the bowel to pass stools naturally. If you use laxatives continually, you may become dependent on them. For most people, slowly stopping use of the laxative will restore the colon's natural ability to contract.4,5
To treat constipation, ask your healthcare provider about the best type of laxative or stool softener for you.
Learn more about how you can best manage other types of chemotherapy side effects.
1. Chemotherapy and you. National Cancer Institute website. Updated May 2007. NIH Publication No. 07—7156. http://www.cancer.gov/cancertopics/chemotherapy—and—you.pdf. Accessed June 4, 2010.
2. Eoff JC, Lembo AJ. Optimal treatment of chronic constipation in managed care: review and roundtable discussion. J Managed Care Pharm. 2008;14(9-a):S3—S17.
3. Haughney, A. Nausea and vomiting in end—stage cancer. Am J Nurs. 2004;104:40—48.
4. Gastrointestinal complications (PDQ®)—health professional version. National Cancer Institute. Updated July 9, 2009. http://www.cancer.gov/cancertopics/pdq/supportivecare/
gastrointestinalcomplications/HealthProfessional/page1.
Accessed June 4, 2010.
5. Constipation. National Institute of Diabetes and Digestive and Kidney Diseases. Updated July 2007. NIH Publication No. 07—2754. http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/Constipation.pdf. Accessed June 4, 2010.
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