Coping with constipation

Heal - Article 04

Constipation is a common side-effect of cancer treatment or medications, such as some painkillers or anti-sickness drugs. It can cause considerable discomfort depending on the severity and, for many, is a topic that is less spoken about than some other side effects. Therefore, it’s useful to be able to both recognise the onset and know what actions you can take to avoid long-term suffering.  

So, let’s start with the basics:

What is constipation?

Constipation, put quite simply, is when you find yourself going to the loo to empty your bowels less than you usually do, or having to strain when you do. You might also feel like you haven’t emptied your bowels fully when you’ve finished.

Whilst we’ve explained that it’s often a common side-effect of cancer treatment, it can also be a symptom associated with poor diet and a lack of exercise.

Why is it important to recognise?

Constipation can cause symptoms such as tummy pain, bloating, nausea, vomiting and poor appetite, and can become serious if left untreated. The longer it’s left untreated, the more difficult it can be to resolve and the more potential for complications such as haemorrhoids (commonly referred to as piles which are blood filled lumps around the bottom) and fissures (a painful split in the skin around the bottom). Paradoxically, severe constipation can even result in a constant leakage of liquid stool material (called overflow diarrhoea) which can be uncomfortable and can make it difficult to leave the house due to the fear of an accident.

How to manage symptoms

The good news is that you shouldn’t take constipation as a given. In fact, there are a number of proactive things you can do to regulate your bowels and decrease the likelihood of you experiencing constipation going forwards:

1. Make sure you’re hydrated

If you don’t drink enough fluid, the waste from the food you eat doesn’t have the lubrication it needs to pass through your colon and out of your body. Drinking enough fluid each day is an important factor in helping regulate your bowels. However, it’s not necessarily going to fix things if hydration wasn’t the cause to begin with. It’s not about drinking more than you need.

The recommendation is to:     

  • Try to drink at least 6-8 glasses of fluid per day (including water, tea and coffee, squash, fruit juice, smoothies and milky drinks)
  • Check if you are hydrated – your pee should be a nice pale colour, not strong and odorous. Other telltale signs that you’re not drinking enough include if your lips are dry and chapped, you feel very thirsty, or you are not peeing much.

2. Adjust your diet

Ensuring you consume adequate amounts of fibre in your diet is key to adding bulk to stool and softening it, making it easier to pass. We cover different food components in more detail within NOURISH but some good sources of fibre include fruit and vegetables and their skins, beans, lentils, pulses, nuts, seeds and wholegrain carbohydrates (like brown rice, wholemeal/wholegrain breads and oats). Ways to proactively increase your intake include:

  • Adding 4-5 prunes or a glass of prune juice into your day
  • Building up to 5 different types of fruit and vegetables each day (increasing fibre too quickly can lead to a lot of gas and bloating)
  • Adding a tablespoon of flaxseeds (or linseeds) a day to cereal, porridge, soups or salads
  • Considering over-the-counter fibre supplements if you’re not managing to get enough fibre from your food, such as:
    • Normacol®
    • Benefiber®
    • Optifibre®

3. Get active

Being more active can stimulate the muscular action of the digestive tract.

  • Try to do a daily walk, dance or workout – anything to encourage that movement!
  • Keep as active as possible throughout your treatment

4. Consider medications

Diet and lifestyle changes might not be enough to help and if you need it, you might want to consider a laxative, either over the counter or on prescription, especially if medications or your cancer itself are the reason for the constipation. Sometimes laxatives are prescribed to prevent constipation and, if you are considered at risk, this might be recommended to you.

Recap

It’s important to recognise when you are suffering from constipation to avoid further complications, and there are a number of actions you can take which could help. Make sure to stay hydrated, introduce more fibre to your diet and keep active. However, as a last resort, there are a number of solutions to talk about with your doctor or healthcare professional.