Constipation happens when stools become less frequent, painful, or dry and difficult to pass. Constipation starts when the body absorbs more water or signals food to move through the bowels more slowly. It is a common but controllable symptom for people with cancer.
- Symptoms of constipation
- Causes of constipation
- Diagnosing constipation
- Managing constipation
- Related Resources
- More Information
- Causes of a GI obstruction
- Symptoms of a GI obstruction
- Treating a GI obstruction
- Bowel obstruction
- Managing bowel obstruction
- Constipation and Impaction
- What Is It?
- The Fatal Four in IDD: How Constipation Impacts Health
- Why is Constipation One of the IDD Fatal Four?
- Risk Factors for Constipation
- The Signs of Constipation
- Treating Constipation
- Complications From Constipation
- 9 Ways DSPs Can Prevent Constipation
- 1) Encourage a well-balanced diet
- 2) Integrate physical activity into the day
- 3) Try probiotics
- 4) Be aware of sodium
- 5) Increase fluid intake
- 6) Discourage alcohol consumption
- 7) Track bowel movements
- 8) Support regular bowel habits
- 9) Consider stool softeners
- Related posts:
Symptoms of constipation
In addition to not being able to empty the bowel, people with constipation may experience the following symptoms:
Pain and cramping
Swelling in the abdomen
Nausea and vomiting
Not being able to urinate
Your health care team can help you manage the symptoms of constipation. Relieving side effects, also called palliative care, is an important part of cancer care and treatment.
It’s also important to talk with your health care team if your symptoms are new or changing. Constipation can be a sign of a more serious problem and you may need more tests.
Causes of constipation
Common causes of constipation for everyone include:
Not eating enough food with fiber
Not drinking enough water or other fluids
For people with cancer, your treatment may be causing constipation. Pain medicine slows down muscles in your digestive tract, making it more difficult to pass your stool. Iron supplements, chemotherapy, and other drugs that are used to treat nausea, vomiting, seizures, depression, diarrhea, or high blood pressure can also affect your digestion.
In addition to the medication you’re taking during cancer treatment, people with cancer may have other causes of constipation:
Scar tissue from surgery or cancer growing in the bowel, which can narrow or partially block your bowel
A tumor or scar tissue completely blocking the bowel, called a bowel obstruction
Cancer pressing on the spinal cord
High levels of calcium in the blood, called hypercalcemia
Low potassium levels
Thyroid gland problems
If you have constipation, your doctor may recommend a rectal examination or an x-ray or other imaging scans. This is to make sure you do not have a tumor blocking your rectum or digestive tract. These tests also help find out if there is hard stool in your rectum.
During your exam, your health care team may ask you about your bowel habits and how they have changed, what medicines you’re taking, your diet, and any other illnesses.
It is very important to treat constipation properly. Without treatment, constipation may damage your intestine or rectum. It can lead to dehydration, block your bowel, and may slow your body’s absorption of medicine. If there is scar tissue or a tumor causing the problem, you may need to have more tests and treatment.
Talk with your health care team about the best way to manage constipation. Some of the following suggestions may help:
Drink more liquids.
Ask your health care team about changing the dose or stopping the medicine that may be causing the constipation.
Eat more fiber or take fiber supplements. But if you have scar tissue or a tumor narrowing your bowel, your doctor may recommend a low-fiber diet. This is because the fiber may back up behind the narrower areas of the bowel.
Be more active.
Use a laxative, an enema, or a rectal suppository. Talk to your health care team first because some of these may be harmful.
Exercise During Cancer Treatment
Side Effects of Chemotherapy
National Cancer Institute: Gastrointestinal Complications
National Cancer Institute: Constipation and Cancer Treatment
American Cancer Society: Constipation
A gastrointestinal (GI) obstruction is when a person’s GI tract is blocked. The GI tract is made up of the esophagus, stomach, small intestine, and large intestine. During the usual process of digestion, food and fluids move through the GI tract. Enzymes, fluids, and electrolytes help the body absorb nutrients during this process.
When a person has a GI obstruction, food and fluids cannot move through the system as usual. A GI obstruction may be from something inside the GI tract that blocks the passage. Something outside the GI tract can also cause an obstruction if it presses on and collapses the GI tract. Sometimes, cancer can stick to the bowel surface, which affects bowel contractions.
When there is a blockage, the intestinal contractions that move the food can cause intense pain. These movements are called peristalsis. A GI obstruction is a serious and even life-threatening problem if it is not treated.
GI obstructions are most common for people with these cancers:
GI obstructions can also occur with many other types of cancers, though less commonly.
Causes of a GI obstruction
Some of the causes of a GI obstruction are:
Stool, or feces, that has become hard and difficult to pass
Twisting of the bowel
Scar tissue in the bowel
A tumor inside the GI tract
A tumor pressing on the outside of the GI tract
Symptoms of a GI obstruction
People with a GI obstruction may have these symptoms:
Vomiting that may contain food, drinks, or medicines taken more than several hours before the vomiting
Pain that feels better after vomiting
Feeling food get stuck as it goes through the GI tract after eating
Cramping from the movement of the intestine as it tries to move food along
Not being able to have a bowel movement or pass gas, despite needing to
Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care. Talk with your health care team about any symptoms you may experience. This includes any new symptoms or a change in symptoms.
Treating a GI obstruction
The treatment of a GI obstruction depends on the cause. Some ways to initially treat or manage a GI obstruction are:
Enemas and other options to loosen and/or soften the stool for a blockage caused by hard stool.
Using a tube to remove what is in the stomach and prevent more pain. The tube, called a nasogastric tube, is inserted through the nose down to the stomach.
Receiving nutrients through an intravenous (IV) tube instead of eating or drinking for a few days. This can help rest and reverse a twisted bowel.
Taking medicine recommended by your doctor to relieve nausea and vomiting, diarrhea, swelling, or pain.
If these options do not relieve an obstruction, the following may be needed:
Surgery to clear a path for food to go through the GI tract
Placing an expandable tube called a stent into the site of the blockage
Types of Cancer
National Cancer Institute: Gastrointestinal Complications
Bowel obstruction is when the small intestine or colon is partly or completely blocked. The blockage prevents food, fluids and gas from passing through the intestines normally. The small intestine is the long, tube-shaped organ in the abdomen that receives partially digested food from the stomach and passes digested food to the large intestine. The colon is the longest part of the large intestine. It absorbs water and nutrients from almost completely digested food from the small intestine and passes waste (stool or feces) to the rectum.
Bowel obstruction may also be called intestinal obstruction or malignant bowel obstruction.
Bowel obstruction can be caused by:
- tumours that block the intestines
- scar tissue or adhesions (bands of scar tissue that bind tissue together) that form after surgery to the small or large intestines
- damage to the intestine from radiation therapy
- certain medicines that affect the digestive tract, such as narcotics, antidiarrheal drugs or some chemotherapy drugs
- fecal impaction, which is when a large mass of dry, hard stool builds up in the rectum due to chronic constipation
Different types of cancer can cause bowel obstructions, including stomach, colorectal, small intestine, uterine, prostate, bladder and ovarian cancers. Cancers that spread to the abdomen and advanced cancers that press against the colon and small intestine as they grow can also cause bowel obstruction.
Symptoms of bowel obstruction can vary depending on its cause and other factors. Symptoms of bowel obstruction include:
- abdominal pain
- abdominal cramps
- swelling, or distension, of the abdomen
- dry mouth
- diarrhea (loose stool may seep past solid fecal matter in the colon)
- not being able to have a bowel movement
- not being able to pass gas, or flatus
- bad breath
Bowel obstruction can lead to a hole, or perforation, in the small intestine or colon. This is called a perforated bowel. It can allow the contents to leak into the peritoneal cavity. This can lead to infection, which is called peritonitis.
Report symptoms to your doctor or healthcare team as soon as possible.
Your doctor will try to find the cause of bowel obstruction. This may include asking questions about your symptoms, bowel patterns, medicines and treatments. Your doctor will also do a physical exam, including feeling the abdomen, listening for bowel sounds and a digital rectal examination (DRE) to check for fecal impaction.
You may need to have the following tests or procedures:
- abdominal x-ray
- CT scan
- upper GI series
- barium enema
Find out more about these tests and procedures.
Managing bowel obstruction
Once the cause of bowel obstruction is known, your healthcare team can suggest ways to treat it. Treatment options may include a combination of measures, including the following.
Resting the bowel
Your healthcare team may suggest resting the bowel for a few days. This means not taking in liquids or food by mouth. You will be given intravenous (IV) fluids to keep you hydrated and keep your electrolytes balanced. Electrolytes are responsible for the movement of nutrients and wastes into and out of cells to keep body fluids balanced. They also allow muscles to function properly.
Relieve pressure in the abdomen
The healthcare team may use a nasogastric (NG) tube to help relieve abdominal swelling and vomiting. The NG tube is passed through the nose, down the throat and into the stomach. An NG tube can be used to remove the contents of the stomach.
A tube can also be passed through the rectum into the colon to help relieve pressure from a buildup of fluid and gas.
You may be given IV antibiotics to prevent or treat peritonitis that can be caused when the contents of the bowel leaks into the peritoneal cavity. The healthcare team may also prescribe medicines to help relieve pain and nausea.
If the obstruction can’t be managed in other ways, you may need surgery to treat it.
The surgeon may use an endoscope to place an expandable metal stent. An endoscope is a flexible tube with a light and lens. A stent is a mesh-like tube. The stent is used to open up the blockage and keep the bowel open. It can also be used to bypass the blockage so that food can move more easily through the intestines.
A gastrostomy is a surgical procedure to create a stoma, or artificial opening, into the stomach through the abdominal wall. A gastrostomy tube can be passed through the stoma into the stomach. The tube can be used to relieve a buildup of fluid and air in the stomach. It can also be used to deliver medicines and liquids directly to the stomach. A drainage bag with a valve may be attached to the tube. When the valve is open, food drains into the bag, not the intestine. This allows soft food and liquid to be taken by mouth without causing any discomfort.
In some cases, the surgeon may need to take out part of the intestine to relieve a blockage or remove dead tissue. After removing the blockage or dead tissue, the surgeon joins each end of the healthy sections of the intestine. Joining the 2 ends of the intestine is called anastomosis. It creates a new pathway or bypass. Depending on where the blockage is and how much intestine is removed, you may have a colostomy or ileostomy. A colostomy is a surgical procedure to create an opening from the colon to the outside of the body through the abdominal wall. An ileostomy creates an opening from the ileum, or the last part of the small intestine, to the outside of the body through the abdominal wall.
Constipation and Impaction
What Is It?
Published: April, 2019
Normally, people have bowel movements at fairly regular intervals, and stool passes out of the body easily without much straining or discomfort. Although the normal frequency of bowel movements varies from person to person, about 95% of healthy adults have a pattern that ranges from three times a day to three times a week.
In constipation, bowel movements either occur less often than expected or the stool is hard, dry and difficult to pass. Most of the time, constipation is not related to an illness or digestive disorder. Instead, the problem is caused by diet, lifestyle, medications or some other factor that hardens the stool or interferes with the stool’s ability to pass comfortably. Some common triggers of constipation in adults include:
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The Fatal Four in IDD: How Constipation Impacts Health
How do you help a person with an intellectual disability achieve a higher quality of life?
Providing support, companionship, and dedicated, compassionate care can go a long way, but the Fatal Four can destroy any foundation you work to build. Dehydration, constipation, aspiration and seizures make up the Fatal Four. These conditions have the potential to severely impact a person’s quality of life and, in some cases, can be deadly.
Why is Constipation One of the IDD Fatal Four?
Nobody likes poop. At best, it’s something we don’t really have to think about very much. At worst, it can kill. Some people even say chronic constipation is what REALLY killed Elvis.
Constipation is generally defined as having no bowel movement in 3 days or having only 3 bowel movements a week. Everyone is different, though, so some people may be constipated even if they do not meet this standard.
In one review, individuals with intellectual and developmental disabilities (IDD) were 250 times as likely as the general population to receive repeating laxative prescriptions. The same review found that 33 percent to 50 percent of the IDD population experienced constipation.
Risk Factors for Constipation
Constipation is often rooted in lifestyle issues, but there are common medical contributors as well:
- Not enough dietary fiber
- Lack of muscle function/tone
- Nerve problems or damage
- Certain medications, including iron and calcium supplements
- Surgery or hospitalization
- Being female
- Being elderly
Some medical conditions, including Crohn’s disease, multiple sclerosis, irritable bowel syndrome, pregnancy, and diabetes, can also contribute to constipation.
Some of these factors are common across the IDD population. For example, individuals with cerebral palsy and Down syndrome commonly have reduced muscle tone. A high percentage of the IDD community experiences limited mobility or uses multiple medications. Individuals with pica eat non-food substances, which can contribute to bowel blockages. As a result, constipation is quite common within the IDD population.
Note that dehydration – one of the contributors to constipation – is another of the Fatal Four conditions that disproportionately affect individuals with intellectual disability.
The Signs of Constipation
Constipation is uncomfortable, and you can likely recognize it in yourself quite easily. However, it can be difficult to tell if someone you support is constipated. Watch for the following:
- Passing stools infrequently. Typically, fewer than 3 in a week or going longer than 3 days in between passing stools is a red flag.
- Hard or lumpy stools. Normal stools are typically soft, but not loose, and form a sausage shape.
- Straining on the toilet. Stool should pass comfortably and with relatively little effort.
- Feeling like you still have to go. Individuals who are constipated may be able to pass a small amount of stool, but not empty their bowels.
- Abdominal bloating or pain. This may be caused by gas trapped in the colon, or in severe cases by the stool itself backing up in the body.
- Gas or liquid stool. Sometimes when feces are trapped in the colon, gas or liquid stool backs up and escapes around the blockage.
Individuals who experience minor or infrequent constipation can often manage it successfully with simple remedies.
- Drinking prune or apple juice can soften stool and help it move through the body.
- Feces may be able to move more easily through the body when a person squats. If the person is safely able to do so, consider helping them squat over the toilet on a footstool. You can purchase stools designed specifically for this purpose.
- A gentle abdominal massage following the shape of the colon may help to move feces through the body.
- Over-the-counter laxatives or suppositories may trigger a bowel movement. Note that in many service settings, you will require a doctor’s order to use even an over-the-counter treatment.
Complications From Constipation
The most severe – and unfortunately, a relatively common – complication from chronic or extended constipation is bowel impaction. Impaction means that the stools in the colon have hardened and become so solid and/or large that the body is not able to remove them. This can be deadly if not treated. Bowel impaction can cause toxins to build up in the body and could lead to a ruptured intestine.
A doctor will often use an x-ray image to diagnose impaction. Signs of impaction typically include:
- Chronic or extended constipation
- Watery or leaky diarrhea
- An urge, but inability, to defecate
- Stomach pain
- Swollen, hard abdomen
- Rectal bleeding
Treatment for impaction requires removing the trapped stool. An enema involves inserting fluid through the rectum into the bowel and may soften the stool enough for it to pass. If an enema is unsuccessful, the impaction will have to be physically removed by a doctor. In severe cases, surgery may be required.
There are additional complications of constipation that are not generally life-threatening but can cause a great deal of discomfort.
- Anal fissures. These small tears in the skin of the anus may provide an entry point for bacteria in the stool to move into the bloodstream. These fissures may become infected or cause pain when a person is trying to have a bowel movement.
- Hemorrhoids. These are swollen veins in the rectum or anus, and they can bulge and cause pain or bleeding when defecating. Hemorrhoids can be caused by straining to defecate when a person is constipated.
- Rectal prolapse. Straining may lead to the extrusion of a portion of the rectum through the anus.
These complications can cause pain when defecating. Unfortunately, this can cause a person to resist having bowel movements, which can in turn increase their risk for constipation.
9 Ways DSPs Can Prevent Constipation
The most effective means of dealing with constipation is to prevent it. Direct support professionals (DSPs) should use these nine tips to help reduce the risk for constipation among the individuals they support:
1) Encourage a well-balanced diet
A diet that contains plenty of fiber promotes the movement of fluids and materials through the digestive system. Some people may experience an increase in constipation when they eat a lot of dairy products or red meat. This could be due to individual sensitivity, or it may be that these products are taking the place of fiber in their diet.
2) Integrate physical activity into the day
Physical activity increases the motility of the digestive tract, and it can help prevent stool from becoming lodged in the intestines.
3) Try probiotics
Some studies have shown that probiotics, like the kinds commonly found in some varieties of yogurt, can improve a multitude of bowel problems, including constipation.
4) Be aware of sodium
Salt in the body can cause the intestines to absorb additional water, drying out the stool and increasing the risk of constipation.
5) Increase fluid intake
Constipation occurs when stools are dry, so increasing fluids can reduce or prevent constipation.
6) Discourage alcohol consumption
Alcohol increases dehydration, and therefore also the risk for constipation.
7) Track bowel movements
Among individuals with risk factors or a history of constipation, track the frequency, size, and consistency of bowel movements. This will enable you to identify possible constipation and intervene early. For individuals who use the toilet independently, consider helping them develop a tracking system that they can complete on their own.
8) Support regular bowel habits
Refraining from having a bowel movement leads to greater hardening of stool, which may cause constipation. Help the individuals you support develop routines, such as using the toilet at a certain time of day, to promote healthy bowel habits. Plan ahead to ensure that people will have opportunities to use the toilet when away from home. Unless absolutely necessary, never advise someone to “hold it.”
9) Consider stool softeners
Many individuals benefit from regular use of stool softeners or fiber supplements to make their stools easier to pass. Note that although many of these are available over the counter, in many service settings you will likely require a doctor’s order to use them.
If a person suffers from frequent constipation despite these strategies, it’s important to alert the person’s medical team. Constipation can be a warning sign of other health problems and may be caused by an underlying and resolvable medical issue.
Constipation stinks, but it doesn’t have to be deadly. Having more information available about this condition in the Fatal Four can help your organization better serve those at higher risk.
DSPs and other caregivers need to know how constipation and the rest of the Fatal Four – aspiration, dehydration, and seizures – interact and potentially cause other serious health problems. The only way to keep the Fatal Four from claiming more lives is education and prevention.
Additional Posts About The Fatal Four
Dehydration Signs and Risk Factors
Aspiration’s Dangers and Key Interventions
What You Need to Know About Seizures