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Managing Constipation

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.

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.

Constipation can have a number of causes, including:
  • Pain medications
  • Chemotherapy drugs
  • Decreased activity
  • Poor diet
  • Inadequate fluid intake
Chemotherapy drugs can cause either an increase or a decrease in peristalsis. 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.

Diagnosing Constipation

Symptoms of constipation include:
  • 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 prevent constipation with lifestyle changes than to treat it once it happens. Here are some tips:
  • 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.

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. 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.

Laxatives and Stool Softeners

Treat constipation:
Laxatives How They Work
Fiber supplements:
Metamucil®, Citrucel®, and Serutan®
Absorb water in the intestines and make the stool softer
Stimulants:
Correctol®, Ex-Lax®, Senokot®
Increase the activity of the intestines
Stool softeners:
Colace®, Dialose®, and Surfak®
Provide moisture to the stool
Saline laxatives:
Milk of Magnesia, Citrate of Magnesia and Haley's M-O®
Draw water into the colon to soften the stool


Learn more about how you can best manage other types of chemotherapy side effects.



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