Constipation is common complaint during cancer therapies. This is usually brought on by the general disruption of the daily routine resulting from extra travelling, stays in hospital or waiting in hospital waiting rooms. 

Other general contributory factors include: 

• anti-sickness medication (eg ondansetron) and pain killers (codeine or morphine) are additional major culprits

• not eating enough fibre

• not being active enough

• drinking an excessive amount of strong tea or coffee (these can be dehydrating)

• bowel muscles weakness – being frail or recent abdominal surgery

• haemorrhoids, or anal fissure can make it painful to defecate

Symptoms of constipation We are all familiar with the symptoms of constipation which most commonly include an uncomfortable feeling in the back passage, bloating and abdominal cramps. There are many other symptoms which are not so immediately obvious. A recent survey of patients with regular constipation reported the following symptoms:

• 65% mentioned discomfort, fatigue & apprehension
• 25% reported irritability and increased arguments with their partners
• 51% admitted feeling less attractive, impacting their social lives
• 38% said they cancelled or left a social engagement early
• 68% said it affected sex either because they felt unattractive or in pain
• 70% reported embarrassment with the extra associated flatulence.

Despite the frequency of this complaint, it is often looked and only addressed when it becomes a significant problem. With some logical foresight however constipation can often be prevented. For example if anti-sickness drugs such as ondansetron are give with chemotherapy consider changing the diet the day before chemotherapy (especially if constipation has been a problem in previous cycles). Try eating three or four dried prunes (or something equivalent if you don’t like prunes) the night before and the morning of chemotherapy. Immediately after chemotherapy it is more difficult to modify diet as there is usually some impairment of appetite but not to worry the fibre will already be in the system. Another good manoeuvre is also to try and go for a brief walk in the fresh air in the evening after the chemotherapy – this may seem alien but not only will it help prevent constipation but it will help the nausea.  Painkiller such a codeine also commonly cause constipation; consider changing the diet before the stools harden rather than wait for the uncomfortable circle of complaint setting it and self perpetuating.

Ways to prevent constipation

• Eat plenty of fibre such as bran, wholemeal bread, cereals, fruit, leafy vegetables, potato skins, beans, dried peas (see below).

• Have a regular routine in the morning and allow your bowels time to work. The best time to go is in the hour after breakfast

• Don’t ignore the call to stool – if you want to go – go don’t be embarrassed to keep people waiting while you sit on the loo with the newspaper until you’ve had a good result.

• Exercise shakes up your bowels and reduces the time motion takes to pass through your bowels (transit time) - your stool will be softer by the time it reaches your rectum easier to pass.

• Use ointment, suppositories to relieve a painful anus.

Dietary tips and constipations

Fruit Try including more fruit in your diet, either tinned, fresh, stewed, pureed or dried.

• Add dried fruit to porridge, cereal or milk puddings
• Slice a banana on your breakfast cereal
• Slice fruit on to desserts such as mousses and cheesecakes

Vegetables and Salad  Try increasing your intake of vegetables including peas, beans and lentils. These can be fresh, frozen, tinned, cooked or raw:-

• Add cauliflower, leeks or broccoli to stews, casseroles, curries, and soups
• Include salad in sandwiches
• Baked beans on toast makes a high fibre snack / meal

Breads and Cereals Eat more wholemeal / wholegrain / granary bread, rolls, pitta bread, chapattis or wholemeal scones etc.

• Cereals such as Branflakes, Weetabix, Porridge, Shredded Wheat or Fruit & Fibre are a good source of fibre.
• Digestive and oat biscuits contain more fibre than plain biscuits such as Morning Coffee or Rich Tea.
• Cereals such as Branflakes, Albran or Fruit & Fibre can be mixed with lower fibre cereals such as cornflakes or Frosties to increase their fibre content

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.