Frequently Un-Asked Questions About Treatment-Related Constipation

Constipation can be caused by a number of factors during your treatment for a blood cancer. Chemotherapy drugs can either cause diarrhea or constipation. Certain pain medications can also slow down your bowels and cause constipation. It's also possible that you are not taking in enough food or fluids because of treatment-related nausea, or not moving around as much as you usually do. This can also decrease your bowel activity.

Whatever the cause, constipation is a side effect that can lead to serious complications. Here is everything you ever wanted to know about treatment-related constipation but were afraid to ask.

This one is a little tricky because everybody has different bowel patterns. Most people normally have bowel movements, or “poops,” every 24 to 72 hours. If you are about 24 hours past due, you should start to intervene to get thing moving.

Other symptoms you may notice if you are constipated include having to “push” harder than usual to move your bowels, or bowel movements that are small, hard, or dry.

Increasing the fiber in your diet gradually is a great start. High fiber foods include bran, fruits, raw and cooked vegetables, dried fruits (prunes, figs, raisins etc) beans, seeds, nuts, and brown rice.

Increasing your fluid intake is also key when you are dealing with constipation. Any non- alcoholic beverage will do the trick, but warm drinks pack an extra punch. It may sound unbearable, but how about trying a glass of warmed-up prune juice?

Laxatives and stool softeners should be taken under the advice of your healthcare professional. If you have received a treatment that is known to be constipating, such as narcotic pain medications or vincristine, or a therapy that has constipated you in the past, ask your doctor about this in advance.

Enemas and suppositories should definitely not be given unless it has been cleared by your doctor. You may have a low platelet count or white blood cell count from your disease or your treatment, and rectal agents may cause bleeding or severe infections under these circumstances.

If your doctor does recommend medications for you, make sure that in your enthusiasm to cure your constipation, you don’t overdo it and end up with diarrhea. As one of my nurse colleagues would say, you don’t need a stick of dynamite to open a soup can! Take any laxative or stool softeners as they are ordered by your healthcare professional.

In addition to increasing your fluid intake and fiber, activity can also help get things moving. This may not be easy if you are feeling tired, but even a short walk or gentle yoga may be enough mobility to kickstart your bowels.

If you are unable to go for a walk, try doing some chair or bed exercises. Tightening and relaxing the muscles in your arms, legs and abdomen are a way to start.

You should call the doctor:

• If changes in diet and activity do not help
• If you experience pain in your abdomen
• For recommendations about which medications to take
• If you have gone for more than 72 hours without a bowel movement, unless this is normal for you

There are many reasons why people getting treatment for a blood cancer might become constipated. Drugs, inadequate fluid intake and decreased activity all contribute to slowing down your bowels.

The best medication for constipation? An ounce of prevention! Ask your doctor if any of the therapies you are receiving for your cancer are expected to cause constipation. If so, get recommendations for stool softeners or laxatives beforehand, and start adding more fiber into your diet right away.

_Sources

_{Curtiss, C. "Constipation" in Yarbro, C., Frogge, M., Goodman(eds.) (2000). Cancer Symptom Mangement 2nd ed. Jones and Bartlett: MA (pp. 191- 197)}