Constipation

Constipation is the experience of having difficulty in passing motion. It is common in people with cancer, and may cause discomfort, cramps, bloating, or pain in the abdominal area. In some people, it can also lead to distressing complications such as urinary problems, nausea, vomiting and loss of appetite. As early treatment will prevent the condition from worsening, it is advisable for you to inform your doctor or nurse if you are experiencing difficulties with your bowel movements.

Causes of Constipation

Cancers affecting the bowels
Cancers affecting the spinal cord
Insufficient fluid intake
Insufficient fiber intake
Decreased physical activity
Medications (e.g. some chemotherapies, anti-nausea medicines, pain medicines, antidepressants, iron supplements)
Electrolyte imbalances (e.g. high blood calcium levels)

What you need to look out for

Consistently having fewer bowel movements than usual
Dry, hardened, sometimes marble-like stools
Leaking small amounts of liquid stools
Straining to open your bowels
Blood in the stools or on the toilet paper after a bowel movement
Feeling that your stools are not emptied completely, even after a bowel movement
Abdominal bloating, pain or cramps
Loss of appetite
Nausea or vomiting
Not being able to pass urine
Confusion

How it can be treated

Your doctor will ask you further questions (e.g. your usual bowel routine, your last bowel movement) and conduct a physical examination, to determine the cause of your constipation. Your doctor may also order for further investigations (e.g. x-rays) if needed. As the treatment for constipation depends on its cause, your healthcare team will be able to advise you in detail on the management plan that is most suited to your condition. For instance, increasing fiber intake is advised in some cases but discouraged if your cancer is narrowing your bowels, since accumulation of fiber in the narrowed areas can cause a bowel obstruction.

Common treatment approaches include:

Laxatives e.g. lactulose, senna, bisacodyl, psyllium
Enemas or suppositories e.g. fleet enemas, glycerine suppositories
Treating the cancer if it is directly causing the constipation
Correcting any electrolyte imbalances
Changing or stopping medications that cause constipation
Increasing fluid or fiber intake
Increasing physical activity

Returning to your regular bowel habit and being able to pass stools easily is the goal of successful treatment. As the above approaches may not be suitable for everyone, be sure to speak to your doctor or nurse before starting on any treatment.

What you can do

The following are some of the do’s and don’ts to help you to manage and prevent constipation:

Try to go to the bathroom at the same time each day, to promote regularity

Open your bowels when you feel the urge to. Do not delay

Exercise as regularly as possible. If you have difficulties getting out of bed, try to exercise the muscles in your abdomen by tightening then relaxing them, and move your legs often while sitting or lying in bed

Hot beverages may help stimulate bowel movements

Gently massaging your abdomen in a clockwise manner may also help stimulate bowel movements

Avoid using laxatives, enema or suppositories on your own. In certain cases, this may lead to bleeding, infection or other harmful side effects. Discuss with your doctor or nurse to ensure it is safe for you to use them

Avoid using a bedpan unless there is a need. A natural position on the toilet or commode is helpful in allowing stools to be passed more easily

When to call your cancer care team

Please inform your doctor or nurse if you notice any symptoms of constipation, or if your constipation does not improve despite treatment.

Please SEEK IMMEDIATE MEDICAL ATTENTION if you develop the following symptoms:

Constipation with the following symptoms that may indicate spinal cord compression:
- Weakness or numbness in the lower body
- New or severe pain over the back, waist or chest area

Constipation with the following symptoms that may indicate bowel obstruction:
- Nausea and / or vomiting
- Abdominal bloating or pain
- Inability to pass wind

If you have any questions regarding the above, please call the Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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