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Constipation is a condition where stool (poop) is hard, difficult to pass, or moves too slowly through the digestive tract. This can make bowel movements less regular and lead to problems such as pain, loss of appetite, hemorrhoids, and breaks or tears in the skin.
Constipation is a common side effect of cancer and cancer treatments. It can cause discomfort, interfere with daily activities, and reduce quality of life. Severe constipation can lead to fecal impaction, a condition where a hard mass of stool becomes stuck in the colon or rectum. Hard stools can also cause cuts or tears in the skin in or around the anus. These tears are called anal fissures. For children with cancer and weak immune systems, these breaks in the skin can lead to serious infection.
Constipation is something that children, and especially teens, may not want to talk about. However, there are ways to manage constipation. Changes in diet, drinking fluids, and being physically active may help. The care team may also recommend certain medicines to help with constipation.
Bowel habits are different for everyone. However, bowel movements should generally occur 3 or more times per week.
Diagnosis of constipation considers:
A medical exam for constipation may include:
As food moves through the digestive tract, nutrients and water are absorbed. Waste is passed out through the colon and rectum as stool. Sometimes, the digestive system slows down, and the stool moves through the intestines too slowly. This can allow more water to be absorbed, making stools hard and dry.
Several factors may lead to constipation during cancer treatment. These include:
A common side effect of some medicines is constipation. For children with cancer, medicines that often cause constipation are pain medicines and anti-nausea medicines. Constipation is a side effect of some chemotherapy drugs like vincristine and vinblastine. Children treated with iron supplements for anemia may also experience constipation.
Types of medicines most likely to cause constipation include:
Opioid medicines are often given to help control pain during pediatric cancer treatment. Some of these medicines are codeine, fentanyl, hydrocodone, methadone, morphine, and oxycodone. Opioid medicines can cause constipation in a few ways:
Because constipation is a common side effect, the care team may recommend a laxative to prevent constipation if an opioid is prescribed.
There are several ways to help prevent and treat constipation in pediatric cancer patients. It is important for families to work closely with the care team to make sure that children’s symptoms are managed. Mild constipation is usually first treated with diet and other behavior changes such as drinking more water and increasing physical activity. The next step in treatment is usually medicine to encourage a bowel movement.
Medicines for constipation are often called laxatives. Laxatives can work in different ways such as by softening the stool or stimulating a bowel movement.
|Osmotic laxatives/ Stool softeners||Stimulant laxatives||Combination medicines|
|Polyethylene glycol 3350 (MiraLax®)||Senna (Ex-Lax®, Senexon®, Senokot®)||Senna + Docusate (Correctol 50 Plus®, Ex-Lax Gentle Strength®, Peri-Colace®, Senokot S®)|
|Docusate (Colace®, Pedia-Lax®)||Bisacodyl (Correctol®, Dulcolax®)|
|Note: It is important to read the ingredients on laxative labels. Many popular brand names have multiple formulas that work in different ways. The brand names are for example purposes only.|
Medicines for constipation are often taken by mouth. Laxatives may sometimes be given as a rectal suppository or enema, but these should only be used if instructed by a doctor.
Many laxatives are available over the counter without a prescription. However, it is very important to talk with the care team before taking any medicine. Laxatives can cause problems such as nausea, cramping, diarrhea, and dehydration when not used properly.
If constipation is caused by opioids, a medicine called methylnaltrexone (Relistor®) may be given to help relieve constipation caused by opioids. The care team may also consider changes to the pain treatment plan.
Nausea, loss of appetite, and fatigue can make it hard for patients to eat enough calories and high fiber foods during cancer treatment. Some diet changes to help constipation include:
In some cases, severe constipation may lead to fecal impaction. When this occurs, stool hardens into a dry mass that becomes stuck in the rectum. The patient is unable to pass the stool. Treatments include giving an enema to add fluid directly into the rectum and colon. A health care provider may also need to perform manual removal of stool by inserting a gloved finger into the rectum to help break apart the mass.
An ileus occurs when the intestines become blocked due to a lack of normal intestinal movement. The condition sometimes occurs after abdominal surgery. This is known as postoperative ileus. Treatment of ileus includes IV fluids, avoiding medicines that cause constipation, and treatment of any underlying problem.
Gastrointestinal decompression may be used to suction out air, fluid, and other contents to relieve pressure and vomiting. This is often done using a nasogastric (NG) tube placed through the nose and into the stomach.
Children with chronic constipation may have pain, itching, and discomfort due to skin irritation, hemorrhoids, or anal fissures. Any cut, break, or tear in the skin in the anal area could lead to infection. Let the care team know about any skin problems. This is especially important for immunocompromised children who are at risk for serious infection.
Some ways to prevent and treat these problems include:
Together does not endorse any branded product mentioned in this article.
Reviewed: February 2019