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    Gastrointestinal Complications (PDQ®): Supportive care - Health Professional Information [NCI] - Constipation

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    Physical assessment will determine the presence or absence of bowel sounds, flatus, or abdominal distention. Patients with colostomies are assessed for constipation. Dietary habits, fluid intake, activity levels, and use of opioids in these patients are examined.

    Management of Constipation

    Comprehensive management of constipation includes prevention (if possible), elimination of causative factors, and judicious use of laxatives. Some patients can be encouraged to increase dietary fiber (fruits; green, leafy vegetables; 100% whole-grain cereals and breads; and bran) and to increase fluid intake to one-half ounce per pound of body weight daily (if not contraindicated by renal or heart disease). (Refer to the PDQ summary on Nutrition in Cancer Care for more information.) A study that involved geriatric patients compared the efficacy, cost, and ease of administration of a natural laxative mixture (raisins, currants, prunes, figs, dates, and prune concentrate) with protocols using stool softeners, lactulose, and other laxatives. Results indicated lower costs, more natural and regular bowel movements, and increased ease of administration with natural laxatives. Even though generalization from these findings was limited by small sample size, additional exploration of natural laxatives in cancer patient populations might be useful.[5] A program for prevention of constipation in cancer patients is described below.

    Assessment:

    • Establish the patient's normal bowel pattern and habits (time of day for normal bowel movement, consistency, color, and amount).
    • Explore the patient's level of understanding and compliance relating to exercise level, mobility, and diet (fluid, fruit, and fiber intake).
    • Determine normal or usual use of laxatives, stimulants, or enemas.
    • Determine laboratory values, specifically looking at platelet count.
    • Conduct a physical assessment of the rectum (or stoma) to rule out impaction.

    Commonly used interventions:

    • Record bowel movements daily.
    • Encourage patient to increase fluid intake, with a goal of drinking eight 8-oz (240-mL) glasses of fluid daily unless contraindicated.
    • Encourage regular exercise, including abdominal exercises in bed or moving from bed to chair if the patient is not ambulatory.
    • Encourage adequate fiber intake. Experts recommend that:
      • Healthy adults consume 20 g to 35 g of fiber per day (average consumption is 11 g).
      • Children and adolescents consume the number of grams of fiber equal to their age plus 5-for example, a 10-year-old consumes 15 g of fiber per day (10 + 5). This guideline applies until age 18 years; at that time, the adult recommendations are followed.

        While there are no specific fiber recommendations for cancer patients, they are encouraged to eat more high-fiber foods such as fruits (e.g., raisins, prunes, peaches, and apples), vegetables (e.g., squash, broccoli, carrots, and celery), and 100% whole-grain cereals, breads, and bran. Increased fiber intake must be accompanied by increased fluid intake, or constipation may result. High fiber intake is contraindicated in patients at increased risk for bowel obstruction, such as those with a history of bowel obstruction or status postcolostomy.

    • Provide a warm or hot drink approximately one-half hour before time of patient's usual defecation.
    • Provide privacy and quiet time at the patient's usual or planned time for defecation.
    • Provide toilet or bedside commode and appropriate assistive devices; avoid bedpan use whenever possible.
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