Constipation

What is Constipation?

Constipation is a decrease in the number of bowel movements and/or the difficult passage of hard stool that often causes pain, discomfort and sometimes bleeding from the rectum. In patients being treated for cancer, constipation can be caused by poor food and fluid intake, and decreased activity. Certain medications, especially pain medications, iron supplements and certain chemotherapy drugs can also cause constipation. Sometimes, the cancer itself, particularly cancers in the gastrointestinal tract, can cause constipation.

The signs and symptoms of constipation include: small, hard bowel movements, no regular bowel movement in 3 days, leaking small amounts of soft stool (like diarrhea) from the rectum, frequent and/or persistent stomach aches or cramps, passing large amounts of gas or frequent belching, bloated or enlarged belly, nausea and/or vomiting.

Management

• Drink eight to ten 8 oz. glasses of non-caffeine fluids daily.
• Add prune juice to your diet. It has a natural laxative effect on the bowel.
• Increase the fiber foods in your diet (whole wheat bread and grains, fresh fruits and vegetables).
• Exercise daily. Even a short walk will be beneficial.
• Prevent constipation. If you are on pain medication, constipation is a side effect of the drugs because it slows down the bowel. Take a laxative daily when on pain medication.

Laxative Protocol

Patients should have a bowel movement at least every two days. Each patient will respond to his or her medication differently. We recommend using Senokot-S, Pericolace, ect. (over the counter medications). The generic forms work just as well.

If you have not had a bowel movement in 2 days you may want to start with the following:

• Take 2 laxative / stool-softener tablets at bedtime.
• If you do not have a BM by morning, take 2 more tablets.
• If you do not have a BM by evening, take 3 tablets, then repeat in the am.
• If there is no BM within 48 hours, take 2 tablespoons of Milk of Magnesia after breakfast and after dinner and continue with the Senokot-S or Pericolace.
• If there is no BM within 72 hours of starting this protocol, use a Dulcolax suppository or a Fleets enema (if your white cells are adequate).
• After having a good BM, use the previous step in your daily laxative protocol. For example if you achieve a BM with step 4 then use step 3 as your daily regime.
• If your stools get too loose then decrease the number of tablets to a comfort level

Do not take antidiarrheal medications!

High-Fiber Foods

Fruit	Vegetables	Breads, Cereals, and Beans
Apples Peaches Raspberries Tangerines	Acorn squash, raw Broccoli, raw Brussels sprouts, raw Cabbage, raw Carrots, raw Cauliflower, raw Spinach, cooked Zucchini, raw	Black-eyed peas, cooked Kidney beans, cooked Lima beans, cooked Whole-grain cereal, cold (All-Bran, Total, Bran Flakes) Whole-grain cereal, hot (oatmeal, Wheatena) Whole-wheat or 7-grain bread