Constipation
Topics covered on this page:
What is cancer-related constipation?
Constipation is a common condition that many cancer patients have. Your stool (poo) becomes hard and dry. It is no longer soft and easy to pass.
- Does it get better? There are many ways to reduce or prevent constipation (see heading What can I do to help manage my constipation?). They may include changes in your diet and lifestyle. Your doctor may recommend laxatives or stool softeners.
What causes constipation?
Here are some possible causes:
- The cancer itself; it may be growing in the intestine or pressing on the spinal cord
- Some cancer treatments you receive; this includes chemotherapy or radiation therapy
- Some antinausea drugs, pain relievers or supplements (e.g. iron, calcium)
- Not enough to drink or being dehydrated
- Loss of appetite may cause you to eat less. This will reduce your number of bowel movements.
- Lack of fibre in your diet; insoluble fibre draws water into your intestine. This makes the stool (poo) softer and easier to pass. Insoluble fibre can be found in wheat bran, for example.
- Overuse of laxatives; this can sometimes worsen constipation
- Too little physical exercise can contribute to constipation
What are the signs of constipation?
Typical signs of constipation can include:
- The need to push hard and strain to get any poo to come out.
- Stools that are hard and dry and are difficult to pass.
- Stomach ache or cramps.
- A bloated or hard belly, a premature feeling of fullness.
- Lots of gas or burping.
- Nausea or vomiting.
- Loss of appetite or desire to eat.
When should I get help for my constipation?
If your constipation gets worse or doesn’t go away, report it to your doctor or another member of your healthcare team. For tips on talking with your healthcare team see Talking to your healthcare professional about your symptoms or concerns. Check with them before trying any over-the-counter medications for constipation. Your doctor or pharmacist may decide to give you a prescription for your constipation. Let your healthcare team know if:
- You have difficulty passing stool (poo) regularly.
- You don’t have a bowel movement for 3 or more days.
- You have stomach pain or cramps.
Talk to someone in your healthcare team immediately if:
- You have noticed blood in your stool.
- You have cramps or vomiting.
- You have diarrhea after taking a laxative.
- You have not had a bowel movement within a day or two of taking a laxative.
What can I do to help manage my constipation?
There are many ways to manage your constipation and to keep it from getting worse. Below are some things you can try.
- Keep a record of your bowel movements. This information can help your healthcare team find ways to relieve your constipation.
- Keep track of these things:
- How often you pass your stool (poo)
- How soft or hard is the stool you pass
- What and when you are eating and drinking
- If you take a laxative then write down when you took it and if it helped
- If you are exercising
- When you have constipation, rate it on a scale of 0 (no constipation) to 10 (worst possible constipation).
- For more information see Symptom Diary.
- Increase the amount of fluids you drink. Drinking fluids throughout the day will help soften the stool (poo) and make them pass more easily. You can sip water during the day. Aim to drink 8 to 10 glasses of liquid per day (1 to 2 litres) except if your doctor advised you otherwise. A good indication of whether you are drinking enough is the colour of your urine. It should be light yellow or almost transparent.
- Try sucking on ice chips if you have trouble drinking.
- Having a caffeine-containing beverage in the morning can also help make it easier to pass stool.
- Find out if there is a dietitian who can advise you what to eat and drink.
- Ask your healthcare team if there are any foods or drinks that you should not have.
- Try to eat small meals and snacks during the day instead of one big meal.
- Eat more fibre if permitted by your doctor. Fruit and vegetables like apples, broccoli, peas, sweet potatoes, spinach, bananas. You can also get fibre from eating whole grain breads and cereals, popcorn, and nuts. When adding more fiber to your diet, it is also important to make sure that you are drinking enough water. A diet high in fibre and low in fluids can worsen constipation. See the suggestions above about the importance of drinking enough water.
- Try to aim for a daily fibre intake of 20 to 35 g. A rapid increase in consumption of fibre can increase bloating and worsen gas. It is best to gradually increase the amount of fibre that you are consuming.
- Limit gassy foods. For example, grapes or beans and vegetables from the cabbage family, because they can make you feel bloated.
- You may try natural laxatives like prunes, pears, peaches, and plums or prune juice, dates and figs.
- Add one or two tablespoons of wheat bran to cereals, fruit juice and milkshakes. This can also help with constipation.
- Always try to go to the bathroom regularly. Your bowels are most active shortly after having a meal. Therefore, try to go to the bathroom after having eaten, as this will be the time where stool is easiest to pass.
- Listen to your body’s signals. When you feel the urge to have a bowel movement, go to the bathroom. Don’t wait, as this can lead to a weakening of these signals over time.
Routine exercise can help you keep regular bowel movements. It is generally fine to exercise during treatment.
- Try an exercise that you like: a light walk, short bike ride, yoga, tai-chi.
- Start slowly and go at your own pace.
- Pay attention to what your body tells you. Only increase the amount and difficulty of your activity when you feel comfortable.
- According to current Canadian recommendations, adults should complete 150 minutes of exercise each week. Including two sessions of strength training each week can help you increase your strength.
- For more information see Get Moving.
- Talk to your healthcare team about taking a laxative to help with your constipation.
⚠ Important information about cannabis
Some patients do use cannabis to reduce pain, help with relaxation or as a sleeping aid. However, the research is still unclear about the use of cannabis to manage cancer-related symptoms, including constipation. It is important to talk to your doctor before trying cannabis. For more information on what cancer patients should know about cannabis, go to: www.bccancer.ca/health-info/coping-with-cancer/medical-cannabis.
Resources
For more information on cancer-related constipation, self-management strategies and support organizations, check out the resources below.
Cancer Care Ontario – Constipation during cancer treatment
Canadian Cancer Society – Constipation
Acknowledgement of sources
The content of this document has been adapted from the following sources:
- Nova Scotia health authority. Constipation. 2019.
- Cancer Care Ontario. Constipation during cancer treatment. 2016.
- BC Cancer. Symptom management guidelines: Constipation. 2018.
- Coping-Together. Getting on top of symptoms. 2013.
- Canadian Cancer Society. Constipation.
- Fondation québécoise du cancer. Constipation.
- CHUM. Constipation related to cancer treatments. 2014.
- Government of Canada. Physical activity tips for adults (18-64 years). 2018.
- Clinical Practice Guideline for the Evaulation and Management of Constipation. 2016.
- Patient education: Constipation in adults (Beyond the Basics). 2020.
- Patient education: Constipation in adults (The Basics). n.d.
Healthcare professional endorsement
The content of this document has been reviewed and approved by a team of healthcare professionals and clinical experts.
Disclaimer
Please note that this fact sheet is not intended as a substitute for consultation with a healthcare professional. Rather, it was designed to complement interventions by your treating team. If you have questions about your health, or any medical issue, you should contact a healthcare professional right away. You should not delay seeking medical advice, or disregard professional medical advice, because of information in this fact sheet. Before beginning any health treatment, always consult your doctor. All care has been taken to ensure that the information contained in this document is accurate at the time of publication. e-IMPAQc is not responsible for any injury or damage to persons or property arising out of, or related to, any use of the fact sheet, or because of any errors or omissions.
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