Constipation

Constipation is a difficulty in opening your bowels. This can often be painful or uncomfortable. It is quite common for cancer patients to experience constipation at some stage throughout their illness. It can be caused by things like changes in diet or activity, some frequently used drugs, and in some cases if the cancer is situated near to and pressing on the bowel. Your doctor might prescribe you medications such as painkillers and anti-sickness drugs which can make you constipated.

The things you eat and drink can help prevent and relieve constipation, so you may be able to manage by making changes to your diet. If these changes don’t relieve your constipation naturally, there are also some effective treatments available that can help to control it. Please ask a member of your hospital team (CNS or doctor) before changing your eating/drinking habits or taking any new medication to relieve constipation. Your CNS is available during office hours and happy to answer any questions you may have. It is not always possible to completely relieve the constipation, but there are many things that can be done to help ease it.

Medication

If you are taking moderate to strong painkillers (such as Codeine or Morphine) or anti-sickness medication, these can cause constipation.

Do not reduce the dose of these medications as this may cause you other problems. Instead, talk to your hospital medical team for further advice.

If you have already been prescribed laxative medication (for example Senna, Dulcolax or Laxido), make sure you take the recommended dose prescribed. It is easier to prevent constipation than to treat existing constipation, so take laxative medication regularly. Some people know when they are likely to become constipated and find it helpful to take laxatives before they even have difficulty opening their bowels. Do not exceed the maximum dose you have been prescribed.

If you have constipation but haven’t been prescribed any form of laxative, there are certain laxatives you can take which can be bought without a prescription such as Senna (Senokot) or Bisacodyl (Dulcolax). Please ask your CNS or doctor before taking any new medication for constipation. Take the maximum dose advised by the pharmacist or indicated on the drug information. Make sure you take the laxatives regularly, and stop taking them once your constipation has gone. Do not exceed the maximum dose. If these laxatives don’t work or you have persistent constipation and stomach pains, please contact your hospital medical team for further advice and to be prescribed some stronger laxatives.

Eating and Fluid Intake

The dietary advice on this page may not be applicable to you such as if you have diabetes, have had oral, stomach or bowel surgery or have difficulty chewing or swallowing. In these situations please contact your medical team for dietary advice that is relevant to you.

There are lots of things you can eat and drink which can help to prevent or relieve constipation.

Please ask a member of your hospital team (CNS or doctor) before you change your eating/drinking habits in order to relieve constipation. This is because some forms of constipation are helped by a high fibre diet while other forms of constipation (e.g. if the cancer is pushing against the bowel) may be helped by a low fibre diet. Your CNS will be happy to advise on dietary requirements specific to your needs.

If you have been advised to eat a high fibre diet:

Having plenty of fibre in your diet can help to keep your bowels working regularly. If you are changing to a high fibre diet, you may experience bloating and flatulence for a few days.

Eating:

Start the day with a high fibre breakfast such as Weetabix®, Shredded Wheat®, bran, porridge or muesli.

Use wholegrain or wholemeal bread, rice and pasta.

Eat plenty of fresh fruit and vegetables, leaving the skin on when possible.

Include more beans, pulses, lentils and oats in your diet.

Snack on dried fruit, nuts and popcorn.

If you eat cakes or biscuits choose ones that are made with wholemeal flour.

Some people find natural remedies for constipation such as flaxseed, syrup of figs, apricots, prunes and prune juice to be quite effective.

Fluid Intake

You could try:

Drinks such as water, fruit juices, soups, and diluted squash. Caffeinated drinks such as tea, coffee, hot chocolate and cola can be taken in moderation, but try to avoid consuming a lot of caffeine.

Try to avoid:

Drinking alcohol.

If you have been advised to eat a low fibre diet:

Reducing the fibre in your diet can help you to pass stools if the cancer is pressing on your bowel. If you are changing to a low fibre diet, please ask your CNS or doctor to give you our advice sheet.

Eating

Start the day with a breakfast such as white bread/toast with spread and seedless jam/honey, or cornflakes/Rice Krispies® with milk.

Use white bread, rice, pasta/noodles and mashed/boiled potatoes (peeled).

Try to reduce the fibre in fruits and vegetables by removing as much of the skins, seeds, pips and stones as possible.

Dairy foods (without fruit or nuts) such as yoghurt, cheese, eggs, butter, margarine, cream and milk do not contain any fibre and can be included in your diet freely.

Tender meat, fish and poultry

Clear soups and cream soups without vegetables (e.g. oxtail, chicken)

Fluid Intake

You could try:

Drinks such as water, tea, coffee, fruit squash, milk and malted drinks (e.g. Horlicks or Ovaltine), can be taken freely through the day as desired.

Try to avoid

Drinking fizzy drinks

General Advice

When you have constipation it is very important to drink plenty of fluids (ideally 2-3 litres a day) as the bowel needs water to make stools softer and easier to pass. A high intake of fibre may also make you more dehydrated.

Chronic Constipation

Faecal Impaction

A faecal impaction means having a large mass of dry, hard poo (stool or faeces) in the rectum that you cannot push out. This happens because you are regularly constipated over long periods of time. Doctors call this chronic constipation.

Causes of Impaction

The main causes of impaction are similar to those of constipation. They include:

Side effects from painkilling drugs.

Lack of exercise over a long period of time.

Low fibre diet.

Long term use of laxatives.

Depression and anxiety.

Symptoms of Impaction

The symptoms of impaction are similar to the symptoms of constipation. But other more serious symptoms can occur. These include:

Back pain due to the mass of poo pressing on the nerves in your lower back (sacral nerves).

A swollen tummy (abdomen).

High or low blood pressure.

A rapid heart rate.

Dizziness.

Sweating.

A high temperature (fever).

Confusion.

Explosive diarrhoea or diarrhoea that you have no control over (see section on overflow diarrhoea).

Feeling and being sick.

Severe abdominal pain.

Dehydration.

Overflow diarrhoea

This happens when constipated poo in your bowel is so hard that you cannot push it out. Sometimes the bowel begins to leak out watery stools around the poo from much higher up in the bowel. This passes round the blockage and out of your bottom.

The leakage from the bowel can cause soiling on your underwear and can also appear like diarrhoea. Doctors call this overflow diarrhoea. In this situation you should not take any anti-diarrhoea medicines. So if you have had severe constipation and then develop diarrhoea, you must talk to your doctor or nurse before taking any medication to stop diarrhoea.

Let your doctor or nurse know if you have any changes in your bowel habits. If you think you have an impaction, don’t take any laxatives without discussing it with your doctor or specialist nurse first. Laxatives that stimulate the bowel can cause severe cramping and may damage your bowel.

Physical Activity and Exercise

Physical activity may help reduce the risk of becoming constipated. If possible, try to take some gentle regular exercise.