Cancer and Gastrointestinal Complications : Constipation

by National Cancer Institute

(Page 2 of 4)

Assessment of Constipation

A medical history and physical examination can identify the causes of constipation. The examination may include a digital rectal exam (the doctor inserts a gloved, lubricated finger into the rectum to check for stool impaction) or a test for blood in the stool. If cancer is suspected, a thorough examination of the rectum and colon may be done with a lighted tube inserted through the anus and into the colon. The following questions may be asked:

• What is your normal bowel pattern? How often do you have a bowel movement? When and how much?
• When was your last bowel movement? What was it like (how much, hard or soft, color)? Was there any blood?
• Has your stomach hurt or have you had any cramping, nausea, vomiting, pain, gas, or feeling of fullness near the rectum?
• Do you use laxatives or enemas regularly? What do you normally do to relieve constipation? Does this usually work?
• What kind of food do you eat? How much and what type of fluids do you drink daily?
• What medicine are you taking? How much and how often?
• Is this constipation a recent change in your normal habits?
• How many times a day do you pass gas?

Treatment

Treatment of constipation includes prevention (if possible), elimination of possible causes, and limited use of laxatives. Suggestions for the patient's treatment plan may include the following:

Keep a record of all bowel movements.

Increase the fluid intake by drinking eight 8-ounce glasses of fluid each day (patients who have kidney or heart disease may need to limit fluid intake).

Exercise regularly, including abdominal exercises in bed or moving from the bed to chair if the patient cannot walk.

Increase the amount of dietary fiber by eating more fruits (raisins, prunes, peaches, and apples), vegetables (squash, broccoli, carrots, and celery), and whole grain cereals, breads, and bran. Patients must drink more fluids when increasing dietary fiber or they may become constipated. Patients who have had a bowel obstruction or have undergone bowel surgery (for example, a colostomy) should not eat a high-fiber diet.

Drink a warm or hot drink about one half-hour before the patient's usual time for a bowel movement.

Provide privacy and quiet time when the patient needs to have a bowel movement.

Help the patient to the toilet or provide a bedside commode instead of a bedpan.

Take only medications prescribed by the doctor.

Do not use suppositories or enemas unless ordered by the doctor. In some cancer patients, these treatments may lead to bleeding, infection, or other harmful side effects.

Impaction

Description and Causes

Five major factors can cause impaction:

1. Opioid pain medications.
2. Inactivity over a long period.
3. Changes in diet.
4. Mental illness.
5. Long-term use of laxatives.

Regular use of laxatives for constipation contributes most to the development of constipation and impaction. Repeated use of laxatives in higher and higher doses makes the colon less able to signal the need to have a bowel movement. (Refer to the Constipation section for causes of constipation that can result in impaction.)

Patients with impaction may have symptoms similar to patients with constipation, or they may have back pain (the impaction presses on sacral nerves) or bladder problems (the impaction presses on the ureters, bladder, or urethra). The patient's abdomen may become enlarged causing difficulty breathing, rapid heartbeat, dizziness, and low blood pressure. Other symptoms can include explosive diarrhea (as stool moves around the impaction), leaking stool when coughing, nausea, vomiting, abdominal pain, and dehydration. Patients who have an impaction may become very confused and disoriented with rapid heartbeat, sweating, fever, and high or low blood pressure. Assessment of Impaction

The doctor will ask questions similar to those in the Assessment of Constipation section and do a physical examination to find out if the patient has an impaction. The examination may also include x-rays of the abdomen and/or chest, blood tests, and an electrocardiogram (a test that shows the activity of the heart). Treatment of Impaction

Impactions are usually treated by moistening and softening the stool with an enema. Enemas must be given very carefully as prescribed by the doctor since too many enemas can damage the bowel. Some patients may need to have stool manually removed from the rectum after it is softened. Glycerin suppositories may also be prescribed. Laxatives that stimulate the bowel and cause cramping must be avoided since they can damage the bowel even more.

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