Constipation and Cancer Treatment

Long-term constipation can lead to fecal impaction, a serious condition where hardened stool blocks the colon or rectum. Unlike ordinary constipation, fecal impaction can be life-threatening and needs immediate medical attention.

• Go to an emergency department, or call 911, if severe belly pain and vomiting come together and nothing at all is moving through. That combination can mean the bowel is blocked, and it is not something to sit out overnight.
• Call your care team the same day if you have had fewer than three bowel movements in the past week, or you notice a feeling of pressure or incomplete emptying, back or belly pain, changes in urination, nausea, or sudden loose stool leaking past a blockage. Those are the signs of impaction.
• Call your care team within a day or two if you are simply constipated. Tell your doctor. They can recommend medicines and other ways to treat it, and treating it early helps prevent more serious problems.

Constipation is the slow movement of stool through the large intestine, the long tube that carries waste out of your body. The longer stool takes to move through, the more fluid it loses. It becomes drier and harder.

If you are constipated, you may be unable to have a bowel movement, need to push harder than usual, or have fewer bowel movements than normal. Constipation may last a short time, or it may be chronic and last a long time.

• Having two or fewer bowel movements in one week.
• Dry, hard, or lumpy stool.
• Pain during a bowel movement.
• Difficulty having a bowel movement.
• Stomach pain or cramps.
• Feeling bloated or nauseous.

Constipation in people with cancer may be caused by:

• Certain types of cancer. Constipation can be a sign of cancers that press on organs in the belly, block the movement of stool, or affect the nerves connected to the bowel.
• Cancer treatments such as chemotherapy. Constipation is a common side effect of some types of chemotherapy.
• Medicines. Many medicines can cause constipation, including opioid pain medicines, anti-anxiety drugs, anti-nausea drugs, and diuretics.
• Lifestyle and diet changes. During treatment you may have less energy for exercise, and your appetite and diet may change. Being less active and eating differently can lead to constipation.

Finding the cause helps you get relief and avoid serious problems. Your doctor will do a physical exam: looking at and feeling your belly, and listening to your bowel sounds. They may ask how often you have bowel movements, when your last one was and what it was like, and whether you have fever, cramps, pain, or bloating.

Sometimes your doctor may do other tests, such as a digital rectal exam, meaning feeling inside the lower rectum with a gloved finger, or an x-ray of the belly, which can show a tumor or impacted stool.

If your doctor expects your cancer or treatment to cause constipation, they may give you tips and prescribe medicine to prevent it. Many of the same steps help if you become constipated.

• Drink plenty of liquids. About 8 cups of water or clear liquids a day helps. Coffee and prune juice can have a laxative effect, and hot drinks can help stool move.
• Try to be active every day. Walking, riding a bike, or gentle yoga may be options. You can also do light exercise in a bed or chair. Ask your team what is right for you.
• Eat at the same time each day. A regular routine can help return you to your usual number of bowel movements.
• Keep a record of your bowel movements. Sharing this with your team helps them treat the problem.
• Ask about fiber before adding it. High-fiber foods and fiber supplements can make constipation worse for some people, so check with your doctor first.

Your doctor may prescribe laxatives to prevent or relieve constipation. Use only medicines and treatments your doctor recommends.

• Osmotics pull water into the bowel to make stool easier to pass.
• Stool softeners soften stool by adding water and fat.
• Stimulant laxatives cause the intestines to contract so stool moves along.

Do not use suppositories or enemas unless your doctor recommends them. In some people with cancer, these can cause bleeding, infection, or other harmful effects.

Side effects like constipation can be hard to deal with, both physically and emotionally. Ask for support from your health care team. If you are caring for someone with cancer, you can help by encouraging fluids, supporting gentle activity, keeping track of bowel movements, and telling the care team about warning signs.