Nutrition in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Nutrition Therapy
Constipation is defined as fewer than three bowel movements per week. It is a very common problem among individuals with cancer and may result from lack of adequate fluids or dehydration, lack of fiber in the diet, physical inactivity or immobility, anticancer therapies such as chemotherapy, and medications used in the treatment of side effects of anticancer therapy such as antiemetics and opioids.[54,55][Level of evidence: I] In addition, commonly used pharmacologic agents such as minerals (calcium, iron), nonsteroidal anti-inflammatory drugs, and antihypertensives can cause constipation.
An effective bowel regimen should be in place before the problem of constipation occurs. Preventive measures should be common practice, and special attention should be paid to the possibility of constipation as a side effect of certain therapies. Suggestions include the following:[52,54]
- Eat more fiber-containing foods on a regular basis. The recommended fiber intake is 25 to 35 grams per day. Fiber should be gradually added to the diet, and adequate fluids must be consumed at the same time (see list below).
- Drink 8 to 10 cups of fluid each day; beverages such as water, prune juice and warm juices, decaffeinated teas, and lemonade can be particularly helpful.
- Take walks and exercise regularly (proper footwear is important).
If prevention does not work and constipation is a problem, the application of a three-pronged approach for treatment is suggested: diet (fiber and fluids), physical activity, and over-the-counter or prescription medication. The use of biofeedback or surgery may also be considered.
Suggestions are as follows:[15,52,54,56,57]
- Continue to eat high-fiber foods and drink adequate fluids. Try adding wheat bran to the diet; begin with 2 heaping tbsp each day for 3 days, then increase by 1 tbsp each day until constipation is relieved. DO NOT EXCEED 6 TBSP PER DAY.
- Maintain physical activity.
- Include over-the-counter treatments if necessary. This refers to bulk-forming products (e.g., psyllium, methylcellulose [Citrucel], psyllium hydrophilic mucilloid [Metamucil (if adequate hydration is tolerated), Fiberall], calcium polycarbophil [FiberCon, Fiber-Lax]); stimulants (e.g., bisacodyl [Dulcolax] tablets or suppositories, glycerin suppositories, and calcium salts of sennosides [Senokot]); stool softeners (e.g., docusate sodium [Colace] and docusate calcium [Surfak]); and osmotics (e.g., milk of magnesia, lactulose, and magnesium sulfate/Epsom salts). Cottonseed and aerosol enemas can also help relieve the problem. Lubricants such as mineral oil would be included in this group but are NOT recommended because of the potential for binding and preventing absorption of essential nutrients.
Good sources of fiber include the following:[19,52]
- 4+ grams per ½ cup cooked serving.
- Kidney beans.
- Navy beans.
- Garbanzo beans.
- Lima beans.
- Split peas.
- Pinto beans.
- 4+ grams per designated unit.
- Corn (½ cup).
- Pears with skin (medium piece of fruit).
- Popcorn (3 cups popped).
- 4+ grams per 1 oz serving.
- Whole-grain cereals (cold).
- Bran cereals (cold).
- 4+ grams per 1/3 cup serving, dry.
- 2+ grams per ½ cup cooked or 1 cup raw serving.
- Green beans.
- Green peppers.
- Canned tomatoes.
- 2+ grams per ½ cup serving or medium piece of fruit.
- Apples with the skin.
- 2 grams per slice or designated serving size.
- Whole wheat bread.
- Whole grain bagel.
- Pita (½ portion).
- Whole-grain crackers.