Constipation

Constipation refers to dry and hard stools, difficulty in defecation or sudden decrease in the frequency of bowel movements. Constipation may cause other discomforts, such as nausea, vomiting, loss of appetite, bleeding haemorrhoids, abdominal distension and pain.

Possible causes include:

• Certain anti-cancer medications or medications used to relieve side effects of cancer treatments. These drugs include:
  • painkillers, especially opioid narcotic medicines, such as morphine or codeine.
  • chemotherapy such as vincristine, vinblastine or vinorelbine.
  • anti-nausea medications such as ondansetron (Zofran) or granisetron (Kytril) 
  • anticonvulsant drugs
• Physical weakness and lack of energy to excrete.
• Tiredness and prolonged rests in beds or a lack of exercise
• Poor appetite, insufficient intake of water, fruits and vegetables/ fibres
• Dehydration
• Electrolyte imbalances in the body, such as high blood calcium
• Overuse of laxatives
• Mental stress, anxiety and depression.
• Tumour compressing or blocking the bowel
• Thyroid problem

You should record the colour, shape and quality of their own faeces, as well as the frequency of bowel movement every day. Tell your doctor about any other symptoms like abdominal pain, nausea or vomiting. The doctor may perform further imaging tests such as:

• Abdominal X-ray
• CT scan

Doctors may precribe medications for constipation:

• Stool softeners, such as colace and ducolax.
• Laxatives: 
  • Laxatives can be used to stimulate bowel activity. Examples are senokot, magnesium salts and lactulose.
  • Laxatives may be given as a suppository placed in the rectum. Suppositories can help promote bowel activity. Examples include glycerine and bisacodyl (dulcolax).
• Sometimes a stool softener and a laxative are used together.

The following suggestions may help with constipation:

• Go to the toilet immediately when needing to defecate. If you are too weak to reach the bathroom, use a bed pan, commode or a diaper.
• Drink a cup of warm water in the morning to stimulate bowel movement
• Stay hydrated and drink more liquids
• Massage the abdomen clockwise for about 15 minutes before bowel movement to facilitate intestinal peristalsis and stimulate the passing of stool to the rectum and anus.
• Do more exercise within tolerable physical conditions.
• Eat vegetabels rich in fibre, such as cereals, vegetable and fruits, especially prunes, papayas, and bananas (except if presence of bowel obstruction).

Smart patient (by Hospital Authority): Constipation

American Society of Clinical Oncology (ASCO): Constipation

Canadian Cancer Society: Constipation

Videos

▶️ Hospice Home: Handling constipation (Chinese version only)

▶️ Commonly used laxative to treat constipation: Commonly used laxative to treat constipation (Chinese version only)