Description and Causes
Assessment of Constipation
Treatment

Description and Causes

Common factors that may cause constipation in healthy people are eating a low- fiber diet, postponing visits to the toilet, using laxatives and enemas excessively, not drinking enough fluids, and exercising too little. In persons with cancer, constipation may be a symptom of cancer, a result of a growing tumor, or a result of cancer treatment. Constipation may also be a side effect of medications for cancer or cancer pain and may be a result of other changes in the body (organ failure, decreased ability to move, and depression). Other causes of constipation include dehydration and not eating enough. Cancer, cancer treatment, aging, and declining health can contribute to causing constipation.

More specific causes of constipation include:

Diet

• Not including enough high-fiber foods in the diet.
• Not drinking enough water or other fluids.

Changed Bowel Habits

• Repeatedly ignoring the urge to pass stool.
• Using too many laxatives and enemas.

Immobility and Lack of Exercise

• Spinal cord injury, spinal cord compression, bone fractures, fatigue, weakness, long periods of bedrest.
• Inability to tolerate movement and exercise due to respiratory or cardiac problems.

Medications

• Chemotherapy treatments.
• Pain medications, including opioids.
• Medications for anxiety and depression.
• Stomach antacids.
• Diuretics.
• Vitamin supplements such as iron and calcium.
• Sleep medications.
• General anesthesia.

Bowel Disorders

• Irritable colon.
• Diverticulitis.
• Tumor.

Muscle and Nerve Disorders (nerve damage can lead to loss of muscle tone in the bowel)

• Brain tumors.
• Spinal cord compression from a tumor or other spinal cord injury.
• Stroke or other disorders that cause muscle weakness or movement.
• Weakness of the diaphragm or abdominal muscles making it difficult to take a deep breath and push to have a bowel movement.

Body Metabolism Disorders

• Under-secretion of the thyroid gland.
• Increased level of calcium in the blood.
• Low levels of potassium or sodium in the blood.
• Diabetes with nerve dysfunction.

Environmental Factors

• Needing assistance to go to the bathroom.
• Being in unfamiliar surroundings or a hurried atmosphere.
• Living in extreme heat leading to dehydration.
• Needing to use a bedpan or bedside commode.
• Lack of privacy.

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 of constipation includes prevention (if possible), elimination of possible causes, and limited use of laxatives. Constipation caused by opioid pain medicine may be treated with a drug given by injection. 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, whole grain breads, and bran. Patients must drink more fluids when increasing dietary fiber or they may become constipated. (See the PDQ summary on Nutrition in Cancer Care ¹ for more information.) 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.

Glossary Terms

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

The opening of the rectum to the outside of the body.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancer).

A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

Having to do with the heart.

Treatment with drugs that kill cancer cells.

An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

Any of several diseases in which the kidneys make a large amount of urine. Diabetes usually refers to diabetes mellitus in which there is also a high level of glucose (a type of sugar) in the blood because the body does not make enough insulin or use it the way it should.

The thin muscle below the lungs and heart that separates the chest from the abdomen.

The things a person eats and drinks.

An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Also called DRE.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

A drug that increases the production of urine.

Inflammation of one or more pouches or sacs that bulge out from the wall of a hollow organ, such as the colon. Symptoms include muscle spasms and cramps in the abdomen.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A state of not functioning normally.

The injection of a liquid through the anus into the large bowel.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

A temporary loss of feeling and a complete loss of awareness that feels like a very deep sleep. It is caused by special drugs or other substances called anesthetics. General anesthesia keeps patients from feeling pain during surgery or other procedures.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

An important mineral the body needs to make hemoglobin, a substance in the blood that carries oxygen from the lungs to tissues throughout the body. Iron is also an important part of many other proteins and enzymes needed by the body for normal growth and development. It is found in red meat, fish, poultry, lentils, beans, and foods with iron added, such as cereal.

A disorder of the intestines commonly marked by abdominal pain, bloating, and changes in a person’s bowel habits. This may include diarrhea or constipation, or both, with one occurring after the other. Also called IBS, irritable bowel syndrome, mucus colitis, and spastic colon.

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

A substance that promotes bowel movements.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

Blockage of a passageway.

A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.

A part of the body that performs a specific function. For example, the heart is an organ.

A measure of weight (one-sixteenth pound) and volume (one-eighth cup).

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

An exam of the body to check for general signs of disease.

A metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

The last several inches of the large intestine closest to the anus.

The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs. Also called respiratory tract.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A mineral needed by the body to keep body fluids in balance. Sodium is found in table salt and in many processed foods. Too much sodium can cause the body to retain water.

A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

The material in a bowel movement. Stool is made up of undigested food, bacteria, mucus, and cells from the lining of the intestines. Also called feces.

In medicine, a loss of blood flow to part of the brain, which damages brain tissue. Strokes are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language. The risk of stroke is increased by high blood pressure, older age, smoking, diabetes, high cholesterol, heart disease, atherosclerosis (a build-up of fatty material and plaque inside the coronary arteries), and a family history of stroke.

Adding nutrients to the diet.

A form of medicine contained in a small piece of solid material, such as cocoa butter or glycerin, that melts at body temperature. A suppository is inserted into the rectum, vagina, or urethra and the medicine is absorbed into the bloodstream.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A gland located beneath the larynx (voice box) that makes thyroid hormone and calcitonin. The thyroid gland helps regulate growth and metabolism. Also called thyroid.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

To eject some or all of the contents of the stomach through the mouth.