CONSTIPATION

 Online Education Module

Learning Objectives
Constipation signs and symptoms
Medical Facts
Preventing Constipation
Managing Constipation
When to Contact your health care provider
Glossary

Learning objectives

  1. Identify the signs and symptoms of constipation
  2. List the steps to take to prevent constipation
  3. Describe what to do if constipation occurs

Identify constipation:  know the signs and symptoms
Constipation is when you are unable to move your bowels as you normally would because you have stools that are too hard, too small, too difficult to expel, and not regular.   Constipation is a common side effect of chemotherapy treatment for a brain tumor.  Untreated constipation can cause discomfort, reduce appetite, and may result in a blockage of the bowel. 

You may develop constipation if you are receiving chemotherapy or taking pain medications (other medications can also cause constipation).   Constipation is a common side effect of the anti-nausea medication Zofran that is often prescribed for nausea and vomiting.  Other factors that might cause you to be constipated can include a decrease in the amount of daily exercise you are doing or a decrease in the amount that you are eating and drinking. 

 


  Medical Fact: (see glossary for definitions of unfamiliar words)

Some medications, such as opioids and chemotherapeutic agents, may cause constipation by slowing peristalsis and increasing transit time.  When transit time is increased, more water and sodium is absorbed by the colon, resulting in dry, hard stools.  Constipation is a side effect of a wide variety of prescribed and over-the-counter medication.  Preexisting laxative dependence can also increase the risk of constipation.

Preventing constipation:  things you can do
The best way to reduce your risk of constipation is to take action to prevent it.   Keeping track of your bowel function and preventing constipation are much easier than treating constipation or obstruction (blockage of the intestine).  Increasing the amount of fiber in your diet, increasing fluids, and exercise are key preventive strategies.  Your bowels should move normally (as they did before you began chemotherapy) with little strain. 

Important things that you should do to prevent constipation are:

  • Drink at least 8-10 glasses of fluid daily
  • Eat foods that are high in dietary fiber, such as fruits, vegetables, whole grains, beans and other legumes, and nuts.   20-35 grams of fiber is recommended.  Talk with your nurse about what is right for you.
  • Exercise daily.  If you are unable to exercise, ask your nurse or physical therapist about exercises that you can do in bed or in a wheelchair.
  • If possible, sit in an upright position on a toilet or bedside toilet when you pass stool.
  • When you get the urge—Go!
  • Take all medications (such as stool softeners) to prevent constipation as prescribed by your physician.

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Management:  If you have an constipation …
Sometimes preventive measures are not enough to keep you from getting constipated.   Medications are often needed to manage constipation when you are having chemotherapy.  It is important to work with your physician or nurse to determine the correct doses of stool softeners and/or laxatives that will keep your bowels moving regularly.

Often a stool softener, such as Docusate is prescribed.   It is important to take the medication as prescribed (usually every night), along with eating a well-balanced diet and doing other preventative measures. 

 


Medical Fact:

Failure to manage bowel function and constipation may result in fecal impaction (also called fecal obstipation).  This happens when hard, dry feces accumulate in the rectum and are not eliminated normally.  This can be a serious and uncomfortable condition.  Initial symptoms include rectal discomfort, lower abdominal or lower back pain, urinary incontinence or retention, and diarrhea.  Treatment by a physician is required.

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When to contact your healthcare provider:
Call your nurse or doctor if you are not able to move your bowels for more than 2 days in a row.  If you go more than 3 days without a bowel movement, you may need stronger medication to relieve your constipation.  Do not use an enema or over-the-counter laxative until you have talked with your nurse or doctor.

We are here to help.  It is important for you to let us know about any side effect of your chemotherapy treatment.  Constipation is important because of the serious danger of bowel obstruction.  Be sure to let us know about any other side effects of your treatment.

  GLOSSARY

antibiotic – a drug used to treat a bacterial infection.  It may be given by mouth or through a vein (IV).

blood cells – cells that make up the blood.   These cells are made in the bone marrow and include white blood cells, red blood cells, and platelets.

blood count – the number of white blood cells, red blood cells, and platelets.

bone marrow – the soft, spongy center of the bone where most of the blood cells are made before they enter the bloodstream.

chills – a feeling of being cold.  This often happens with fevers and may include shaking.

intravenous – giving fluid or medicine into a vein through a needle.  Also called an IV.

constipation – occurs when unable to move bowels.  Narcotic pain medications, some chemotherapy drugs, antinausea medicines, and changes in diet can cause constipation.

diarrhea – a change in stool consistency or form (bowels are loose, watery, or move more frequently).  May be accompanied by stomach cramps.

fever – body temperature above 98.6  F.

flu-like symptoms – includes muscle aches, fever, chills, shakes, weakness, headache, upset stomach, and diarrhea.  These may be a symptom or sign that you are ill or may be a side effect of chemotherapy drugs.

immunization – a vaccine to protect us from disease (such as measles and chicken pox).  It is important for patients having chemotherapy to avoid children who have recently had immunizations because the vaccines are sometimes made from the actual bacteria.

infection – occurs when a germ/bacteria enters the body and the person is unable to fight it off.  This can happen when a person is undergoing treatment for a brain tumor.  Signs of infection include fever, fatigue, chills, muscle aches.

injection – giving medicine using a needle into the muscle, under the skin, or into the vein.

intravenous – giving fluid or medicine into a vein through a needle.  Also called IV.

nadir – period after chemotherapy treatment when blood counts are their lowest number.

neutropenia – a condition when the number of neutrophils in the blood counts are low.

neutropenic – a term used to describe a patient when the number of neutrophils in the blood counts are low.

neutrophil – a type of white blood cell that kills bacteria.

platelet – a type of blood cell that helps the blood to clot.  Chemotherapy can lower platelet count.

red blood cell – the cells in the blood that carry oxygen to the organs and tissues and take carbon dioxide away.

side effect – a symptom or a reaction that a person may have to brain tumor treatment.

swelling – when fluid fills the spaces between the cells in parts of the body.  Swelling (also called edema) often occurs in the ankles and feet and may be a sign of infection.

subcutaneous – under the skin.

symptom – any change in the body’s function that would indicate disease or a reaction to treatment.

temperature – how hot the body gets.  Normal body temperature 98.6  F (Fahrenheit).

thermometer – a tool used to check body temperature.  There are various types available.

urination – emptying of urine from the bladder (“passing water”).

vaginal discharge – fluid or mucus that leaks from the birth canal or vagina and may have a strong odor which is a sign of infection.

white blood cell – cells in the blood that fight infection or germs.  Neutrophils are one type of white blood cell.

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References
Oncology Nursing Society, Neutrophil your one-in-a-million bodyguard guides you through neutropenia, ATAQ Community Education Project.

Yarbro, C.H., Frogge, M.H., and Goodman, M. (2004) Cancer Symptom Management, 3rd edition, Sudbury, MA: Jones and Bartlett.

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