Managing Constipation and Cancer

Managing Constipation and Cancer
Managing Constipation and Cancer

Reported in as many as 6 in 10 cancer patients1, constipation is a common finding, worsening as cancer progresses.

Unmanaged constipation with the subsequent bloating and uncomfortable gut can worsen a cancer patient’s distress.

While it is not a topic that people speak about much, diet and lifestyle really can play a role in helping to manage constipation in those with cancer.

What is Constipation?

Constipation occurs when bowel movements become difficult to pass and become infrequent. ‘Normal’ bowel movements can range greatly from person to person.

By definition, the range of normal bowel movements in healthy people can range from three times per day to three times per week.2

Anything less than this and you have constipation.

The other concern is stool consistency.

Stools should be easy to pass, soft and sausage-like.

Hard, pebble-like stools are an indication of constipation, even if you fall within the guidelines of passing stools three times a week.

Why Does Cancer Cause Constipation?

Constipation is the third most common symptom in cancer patients3 (after pain and loss of appetite).

The risk of constipation is higher in cancer patients taking certain medications, like opioid analgesics or medications with anticholinergic properties.

Constipation is also a higher risk in those with cancer of the gut/bowel. Firstly, growing tumours may obstruct the movement of stools through the gut.

Secondly, as part of cancer treatment, parts of the gut may be removed to manage growing tumours.

How Can I Manage Constipation?

    1. Be Water Wise

      It is important to drink lots of water to prevent constipation. Water helps to bulk up the contents in the gut and move the contents along better.

      • Aim to drink at least 2L of water each day.
      • Purchase or use a few 500/750 mL bottles, fill them with filtered water and leave them in easy-to-grab spots like your office desk, car, kitchen fridge, etc.
      • If you find water boring, then try sparkling water: it’s just as good but more fun.
      • On cooler days, drink a cup of hot water with a squeeze of lemon. Rooibos tea (without milk) and hot water with lemon juice/slices or mint can be counted as water intake.
      • If cancer treatment like chemo leaves you with a dry mouth, it may help to drink more liquids like soups and smoothies. This will also help increase your fluid intake.
      • Add a shot of ginger juice or FitChef’s Immune Booster shots (with ginger, lemon etc) to water to flavour it.
      • Start drinking water early in the day. You may find that the more water you drink, the more you want.
    2. Focus on Fibre

      Fibre acts like a broom in the intestines and helps sweep the gut to move stools along for easier passing.

      • Avoid processed starches where the fibre has been removed. Include mostly high fibre starches e.g. brown rice, wholewheat pasta, oats, bran flakes, etc.
      • Eat fruits and vegetables (where possible) with skin, pips, and seeds. Aim for 3 – 5 servings per day.
      • Dried fruits (especially prunes and pears) may help with constipation.
      • Bulk up your meals with beans, chickpeas, and lentils. Sneak lentils in mince dishes, chickpeas into stews, and go meat-free once a week to increase your intake of these high fibre plant proteins.
      • Learn to read food labels and choose products that contain more than 6g of fibre per 100g of product.
    3. Avoid Processed Food

      Avoid food products that are refined as these have the fibre taken out during processing. Rather chose wholegrain/wholewheat options of these foods, as mentioned above.

    4. Get Active

      Exercise helps get the gut moving, because as you exercise the muscles of the body you also exercise the muscles of the gut.

      • Cancer treatments like chemo may leave you feeling tired and weak. As far as possible, aim for 3-4 days a week of being active, not only for the gut but to help maintain muscle mass with cancer.
    5. Speak To Your Doctor About Medication

      Some chronic medications may contribute to constipation so take note of the side effects of any medication you are on.

      • While multivitamins should not affect constipation, iron and calcium supplements may cause constipation.
      • Over-the-counter laxative products, rectal suppositories, enemas, and methyl-naltrexone (a prescription drug) may be suggested by a treating doctor. Bulking agents (e.g. fibre supplements like psyllium), stool softeners, stimulant laxatives (e.g. Senna, Movicol), and osmotic laxatives (e.g. Epsom salts, lactulose) may also be needed.

References

    1. Wickham RJ. Managing Constipation in Adults with Cancer. J Adv Pract Oncol. 2017;8(2): 149–161.
    2. Cresci G, Escuro A. Medical nutrition therapy for lower gastrointestinal tract disorders. Chapter 28, page 525 – 559. In: Mahan L, & Raymond J. (2017) Krause’s Food and the Nutrition Care Process.
    3. Clemens KE, Faust M, Jaspers B, Mikus G. Pharmacological treatment of constipation in palliative care. Curr Opin Support Palliat Care. 2013 Jun; 7(2):183-91. .
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