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What Helps With Constipation From Chemo

Increase Your Fiber Intake

Let’s Talk Chemo: Coping with constipation and diarrhea

About 25 to 50 grams of fiber is recommended per day. High-fiber foods include those rich in whole grains, like some breads and cereals. Fruits, vegetables, brown rice, and beans are also good choices. Nuts or popcorn make healthy, high-fiber snacks.

A examined the relationship between eating sweet potatoes and constipation in 120 people with leukemia who were undergoing chemotherapy. Results showed the sweet potatoes were helpful in reducing and preventing constipation.

Soluble fiber products, like Benefiber and Fiber Choice, are another way to increase your daily intake.

Constipation In The Cancer Patient

When you have cancer, constipation is more likely to occur because of the cancer itself or as a side effect of treatment. If you have constipation, your doctor or nurse can help you to treat it and prevent it in the future.

When you have cancer, constipation is more likely to occur because of the cancer itself or as a side effect of treatment. If you have constipation, your doctor or nurse can help you to treat it and prevent it in the future.

Cannabinoid Receptor Inhibition And Activation

Cannabinoids mediate their effects via binding to two main G-protein coupled receptors, CB1 and CB2, widely expressed in the GI tract . Although the activity of the endocannabinoid system varies between species and different regions of the GI tract within the same species, activation of CB1 receptors coupled to cholinergic motor neurons has been found to inhibit excitatory neuromuscular transmission in human colonic circular muscle and inhibit colonic propulsion in mice and rat . In recent human trials, dronabinol, a non-selective cannabinoid receptor agonist, was found to inhibit colonic motility in both healthy subjects and patients with IBS-related diarrhea . Conversely, a CB1 receptor inverse agonist, taranabant, has been shown to improve symptoms related to slow GI motility and abdominal pain when administered in vivo in mice . Taranabant increased the number of bowel movements after systemic and oral administration and significantly increased fecal pellet output in mice with constipation induced by ipratropium . It has been demonstrated that a low dose of a non-selective cannabinoid agonist WIN55,212-2 reduced the severity of 5-fluorouracil-induced diarrhea in rats .

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Normal Bowel Habits And Constipation

The range of normal bowel movements in healthy people is arbitrarily defined as three BMs per day to three per week . In general, constipation occurs because prolonged bowel transit allows more water to be absorbed from feces through the bowel wall, which leads to hard, dry, and difficult-to-pass stools . Many authors use the Rome III criteria to define constipation characteristics, but these criteria for functional constipation do not consistently fit with constipation in advanced illness .

Rome III Diagnostic Criteria for Functional Constipation

Constipated stools can range from small, hard “rocks” to large bulky masses and may be accompanied by discomfort or pain . Other related manifestations may include abdominal distention and bloating, urinary retention, nausea, anorexia, and rectal problems . Constipation can also cause paradoxical or overflow diarrhea, as liquid stool passes around the obstructing constipated stool. Chronic constipation can also lead to fecal impaction, particularly in patients with advanced disease who have poor oral intake with little dietary fiber, dehydration, limited physical activity or immobility, or abdominal tumor .

Possible Causes of Constipation in Persons With Cancer

What Can I Do To Manage My Constipation

Pin on remedies

Just as every cancer patients treatment is different, the way each person responds to his treatment is also different. While one person may have constipation, another may not. However, there are things you can do to help deal with this treatment side effect.

  • Do not take any over-the-counter medicines for your constipation without talking to your doctor or health care team.
  • Drink at least eight 8-ounce glasses of water a day. It is important to put back the fluids you lose. A glass of warm liquid when you first get up in the morning may start your bowels moving.
  • Add more fiber to your diet. Eat more whole grains, such as bran muffins and cereals, wheat germ, and whole wheat bread, fresh fruits and vegetables, and prunes or prune juice.
  • Eat fewer fatty foods .
  • Increase your daily exercise. Even a daily walk can help relieve constipation.
  • Speak to your doctor and health care team about medicines you can take to help you.

Plan For Managing Your Constipation

  • What foods and drinks will help relieve your constipation?
  • What foods should you stay away from if you have constipation?
  • How do you get in touch with your doctor or health care team if you need help?

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How Is Constipation Treated

Your doctor will want to treat any medical conditions that might be causing constipation. Laxatives or stool softeners should be used ONLY if your doctor and nurse recommend them. To treat or prevent constipation: Drink more fluids water and juices are best. Increase dietary fiber. High-fiber foods include bran, cereals, whole wheat bread, nuts, fresh or dried fruits , raw or cooked vegetables, and pasteurized fruit juices . Be sure to talk to your doctor first. Fiber may not be recommended for patients with certain cancers. Also, when you eat more fiber, you need to drink more fluids. Ask your doctor about your fiber and fluid goals. Avoid chocolate, cheese, eggs, fatty foods, meat. Get as much exercise as you can. Ask your doctor how much and what type of exercise is best. Go to the bathroom when you feel the urge to go. Have a warm or hot drink about 30 minutes before the time you usually have a bowel movement. Find a private, quiet place to use the bathroom.

Current Treatments For Chemotherapy

Chemotherapy-induced diarrhea may be classified as uncomplicated or complicated , early onset or late onset and may be categorized as persistent or non-persistent according to the National Cancer Institutes Common Terminology Criteria for Adverse Effects grading system . Although uncomplicated CID may be managed by modification of the diet and administration of standard anti-diarrheal drugs such as loperamide, octreotide and tincture of opium, complicated diarrhea requires aggressive high dose anti-diarrheal administration and hospitalization . The recommendations on the management of CID were published in 1998 and updated in 2004 , providing guidelines for evaluation and management of CID. These guidelines have not been updated since 2004. Currently the only drugs recommended in the updated treatment guidelines are opioid derivatives such as loperamide and deodorized tincture of opium , and octreotide.

Loperamide

Deodorised Tincture of Opium

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Tips To Reduce Constipation During Cancer Treatment

  • Discuss constipation with the doctor to determine a cause before using any constipation remedy.
  • Contact the doctor if there has not been stool for three days or longer.
  • Ask your doctor if increasing intake of fiber would be helpful. If you are having problems with weight loss, you will not benefit from increasing the fiber in your diet.
  • Add high fiber foods in small amounts, increasing intake over several days for a total of 25 35 gms per day.
  • Eat at the same time every day.
  • Read food labels for fiber content.
  • Eat skins of smooth fruits and vegetables.
  • Drink 8 10 cups of fluid each day, including prune juice, warm teas, and hot lemonade.
  • Limit food and beverages that cause gas, including carbonated beverages, cabbage family foods, and dried beans or onions.
  • Mild exercise such as walking will help stimulate bowel movements. Make sure you talk with your doctor first before starting regular walking.
  • Do not use rectal suppositories unless you check with your doctor.

Increasing fiber in your diet will not prevent or help treat the constipation caused from pain medicine. If you take pain medicine on a regular or daily basis you will need instructions from your doctor on how to prevent constipation or how to resolve it if it develops.

Focused Bowel History And Physical Assessment

How to Manage Constipation During Chemotherapy

A patients self-report of constipation, which can be gained by a reliable and valid screening tool , should be incorporated into a more thorough focused history and physical examination to confirm constipation . Assessment parameters include:

  • What the patient considers “normal” BMs
  • Usual bowel habit, duration of feeling constipated, date of last BM
  • Current stool appearance
  • Associated symptoms
  • Likely causes and contributing factors :
  • Medication history, including laxatives, suppositories, enemas
  • Medical conditions affecting laxative selection
  • Current diet and desire to eat as well as fiber intake
  • Activity level, altered mobility, fatigue, or weakness, which may interfere with usual normal BMs.
  • Laboratory tests, per se, are not indicated except to identify contributing factors for constipation or risks from particular interventions . Similarly, a flat plate of the abdomen may differentiate severe constipation, fecal impaction, and obstruction .

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    When Should I See A Doctor About My Constipation

    If youre struggling with constipation as a result of your chemo treatment, despite making diet and lifestyle changes, its important to talk to your medical team. There are a range of medications which may be able to help, including laxatives, emollients and lubricants, and they can advise on whats suitable for you.

    You should also contact your doctor if you are suffering from pain, swelling or hardness in your stomach, fever, nausea or vomiting, or if you have not had a bowel movement for 2-3 days despite following any advice given.

    Constipation can be a common side effect of chemotherapy. However, by making some simple diet and lifestyle changes you can help to reduce the effects and make life more comfortable.

    Do you have any tips for managing constipation during chemo, or are you looking for more advice? Visit the Live Better With cancer forum.

    How Can I Help Control Diarrhea

    If you have diarrhea, consider foods such as the following:

    • Yogurt and cottage cheese
    • Farina and cream of wheat
    • Smooth peanut butter
    • Canned, peeled fruits and well-cooked vegetables
    • Skinned chicken or turkey, lean beef and fish

    With diarrhea, try to avoid the following types of foods:

    • Fatty and fried foods
    • Fruit seeds, skins and stringy fibers
    • Vegetables high in fiber such as broccoli, corn, dried beans, cabbage, peas and cauliflower

    Some people need to avoid milk and dairy products when they have diarrhea, because they may not tolerate the lactose contained in these products.

    In addition, consider the following information provided by the National Cancer Institute as ways to reduce the severity of your symptoms:

  • Avoid high-fiber foods that may cause diarrhea and cramping. These include whole grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn, and fresh and dried fruit. Other foods that may cause cramping and diarrhea include coffee, tea with caffeine, alcohol, sweets, and fried, greasy or highly spiced foods.
  • Avoid milk and milk products, including ice cream, as diary may aggravate your symptoms.
  • Keep the rectal area clean and dry using a mild soap. If necessary, your physician may recommend an ointment or cream for irritated skin.
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    Guanylate Cyclase C Activation

    Guanylate cyclase C is the principal receptor for heat-stable enterotoxins and plays a major role in E. coli-induced secretory diarrhea . Enterotoxins and endogenous peptides bind to guanylate cyclase C and stimulate the production of intracellular cyclic guanosine monophosphate . Increased levels of cGMP activate the secretion of chloride ions through the cystic fibrosis transmembrane conductance regulator. Linaclotide is a minimally absorbed 14-aminoacid peptide that selectively stimulates intestinal epithelial cell guanylate cyclase C receptors, resulting in increased intracellular and extracellular cGMP leading to accelerated stool transit and laxation . In phase II and III placebo-controlled studies in chronically constipated and IBS-C patients, linaclotide was found to accelerate colonic transit and improve abdominal pain and symptoms of constipation . Linaclotide is particularly interesting in that it is both a laxative and analgesic, reducing visceral hypersensitivity with very few drug interactions, it is presently licensed for chronic idiopathic constipation and IBS-C in the USA , but no trials on CIC have been reported to date.

    Putting It All Together

    Diet to Tackle Side

    Advanced practitioners can be instrumental in developing and implementing bowel protocols in their practice settings. These protocols are not only appropriate for patients undergoing cancer treatment, but often become useful for cancer survivors and those who experience progressive disease and receive palliative care. As discussed, there is little research to support laxative selection and dose escalation for patients with cancer, OIC, or those receiving palliative care constipation management recommendations are largely based on consensus . Such recommendations have been published by Canadian and European authors. In the United States, the Oncology Nursing Society also has links to clinically useful resources and summary recommendations .

    Factors to considers when formulating a laxative plan include the patients prognosis and relative health, whether the patient is already constipated or constipation is likely , planning strategies that may help the patient adhere to a laxative plan , and making timely adjustments to the plan as indicated.

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    Nutritional Management Of Constipation

    Some anticancer medications, pain medications, and other medications cause constipation, a condition in which the stool becomes hard and dry, making it difficult to pass. Waste matter that stays too long in the bowels so that too much water is absorbed from the stools will initiate constipation. The following suggestions may help to prevent or alleviate constipation:

    • Drink plenty of liquids, especially water – at least eight big glasses every day.
    • Drink a hot drink such as hot tea one hour before your usual time for a bowel movement.
    • Try to avoid gas-forming foods and beverages such as broccoli, cabbage, and carbonated beverages.
    • Try to get some exercise every day to help prevent constipation.

    If you have not had a bowel movement for a day or two, call your physician who may suggest taking a laxative or stool softener. High-fiber foods will help constipation but check with your physician or registered dietitian before you eat these foods because there are certain types of cancer for which a high-fiber diet is not recommended.

    The following are high-fiber foods that may help to relieve constipation :

    • Whole-grain breads and cereals
    • Fresh fruits and vegetables including the skin on your potatoes
    • Dried beans and peas

    How May My Constipation Be Treated

    Constipation is a common side effect or unwanted change in your body when you have chemotherapy treatment. Constipation can make you feel very uncomfortable. The most important thing for you to remember is to not let your constipation go on for days and days, but to get help right away. If you do not have a bowel movement for two days, you should tell your health care team right away. There are medicines that your doctor or health care team can give to you that will make your constipation better.

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    When Should I Call The Doctor

    When it comes to bowel movements, everybody has a different regular or normal. If youre eating less, you may notice a decrease in your bowel movements.

    Still, its important to maintain regular bowel movements during chemotherapy. Hard stools and constipation can lead to bleeding if your blood counts are low.

    The National Cancer Institute recommends letting your healthcare provider know if you havent had a bowel movement in two days.

    What Will I Learn By Reading This

    Constipation from Cancer Treatment / Chemotherapy – Tips and Coping Mechanisms

    When you have chemotherapy to control your prostate cancer, you may have side effects or unwanted changes in your body. Side effects are different from person to person, and may be different from one treatment to the next. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. You will learn:

    • What constipation is
    • Why does chemotherapy cause constipation
    • Things you can do to manage your constipation
    • When to call your doctor

    It is important for you to learn how to manage the side effects you may have from chemotherapy so that you can keep doing as many of your normal activities as possible.

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    Conflict Of Interest Statement

    The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    The reviewer HA and handling Editor declared their shared affiliation, and the handling Editor states that the process nevertheless met the standards of a fair and objective review.

    How To Manage Constipation

    You can manage constipation in a variety of ways. An essential first step is to notify the healthcare provider of constipation. It helps to be thorough when listing your medications to your healthcare provider because many medicines used in cancer treatments and pain relief can cause constipation. These questions will help determine the exact cause of constipation.

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    Coping With Indigestion Or Heartburn

    Some cancer drugs can make you more likely to have indigestion. Indigestion is a sensation between your belly button and breast bone and can feel like:

    Some drugs may also cause heartburn, which is a burning sensation in the lower chest. The backflow of food and stomach acid from the stomach into the food pipe causes heartburn.

    Your doctor or nurse can prescribe anti acid for indigestion or heartburn. Other medicines like anti sickness drugs may also help.

    Expert Review And References

    Monkey on a Tire Swing: My Chemo Course
    • Understanding chemotherapy: a guide for patients and families. American Cancer Society. American Cancer Society. American Cancer Society 2013.
    • American Cancer Society. Nutrition for Children With Cancer. Atlanta, GA: American Cancer Society 2012.
    • Constipation. American Society of Clinical Oncology . Cancer.Net. Alexandria, VA.: American Society of Clinical Oncology 2009.
    • Constipation. BC Cancer Agency. Patient/Public Info. Vancouver: BC Cancer Agency 2006.
    • Camp-Sorrell, D. Chemotherapy toxicities and management. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett 2011: 17: pp. 458-503.
    • Gamulka B, SickKids Constipation Working Group. Constipation. Hospital for Sick Children. AboutKidsHealth. Toronto, ON: Hospital for Sick Children 2013.
    • Hospital for Sick Children. AboutKidsHealth: Side Effects of Chemotherapy. Toronto, ON: Hospital for Sick Children 2009.
    • Constipation. National Childhood Cancer Foundation & Children’s Oncology Group. CureSearch. Bethesda, MD:
    • Panzarella C, Rasco-Baggott C, Comeau, M., et al. Management of disease and treatment-related complications. Baggott, C. R., Kelly, K. P., Fochtman, D. et al. Nursing Care of Children and Adolescents with Cancer. 3rd ed. Philadelphia, PA: W. B. Saunders Company 2002: 11:279-319.

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