What is constipation?
Constipation is a very common condition even amongst the non-cancer population, however, individuals with lung cancer frequently encounter constipation during their illness, for a number of reasons.
Everyone's normal bowel pattern is different, but as a general guide you should let your doctor or nurse know if you've not had a bowel movement for three days, unless this is usual for you.
Signs of constipation include:
· having less frequent bowel movements
· your stools becoming harder
· straining to pass motions
· a feeling of not having emptied your bowel but being unable to pass any more stool
· your tummy becoming bloated or uncomfortable.
Causes
There are many causes of constipation, often lung cancer patients believe it is due to their poor appetite and do not realise it needs to be assessed and managed in its own right. Causes can be because of medications, or chemical imbalances in the blood, or indeed a change in diet, or being less mobile, also a lack of fluid intake and dehydration can cause and worsen constipation. Even though it can be embarrassing to talk about constipation it is really important that you let your GP or health care team know if you are, or are becoming, constipated. This way assessment of the cause can be made and advice and/or laxatives and/or another intervention can be given to try to relieve this problem.
Management
The management of constipation depends on the cause, so your GP, specialist nurse or hospital team will take a history of the problem. They will ask if you have suffered this in the past, and if so what has worked for you before. They will ask about your current medications; and about your fluid and dietary intake; and activity levels. They will also need to know the symptoms of constipation you are suffering. Here are some things that can help:
· Try to have plenty of fibre in your diet. Good sources of fibre include wholegrain breakfast cereals, porridge, muesli, wholemeal bread and flour, brown rice, wholemeal pasta, and fresh fruit and vegetables with their skins on.
· Drink plenty of fluids. Aim to drink at least two litres (3½ pints) of fluid a day.
· Gentle exercise will help keep your bowels moving.
· Natural remedies for constipation include apricots, prunes, prune juice and syrup of figs.
· Medications known to cause constipation may need to be reviewed, by your nurse or medical team, please do not stop any medication until you have discussed this with them.
· If you medical team find that you have a high calcium level this can contribute to dehydration and constipation and they may arrange for some intravenous medication over a short number of hours to be given at your local hospital, which can reverse this.
· There are many laxative preparations that can be used, see below:
Laxatives - There are different types of laxative available. Your doctor or nurse will recommend a specific type of laxative, depending on the cause of the constipation.
· Softening laxatives, for example lactulose, encourage more water to be taken up by the bowel, making stools softer and easier to pass along.
· Stimulant laxatives, such as "Senna", increase the movement of the bowel wall to help push stools along.
· Some laxatives combine a softening laxative with a stimulant laxative (for example Co-danthramer).
· Bulk-forming laxatives, for example "Fybogel", increase the volume of stool. This is similar to the role of fibre in your diet. These laxatives can take a few days to work and need to be taken with plenty of fluid to be effective.
If you're very constipated, or if the laxatives aren't working, your doctor or nurse may recommend suppositories or an enema. These preparations are inserted into the bowel through the back passage.
References
http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Aboutsymptoms/Commoncancersymptoms.aspx#DynamicJumpMenuManager_6_Anchor_11
Curtiss, C. Constipation. In: Yarbro, C.H. et al. 1999. Cancer Symptom Management: Chapter 27, pp 508-521. Jones and Bartlett Publishers, Sudbury, Massachusetts. 2nd Edn.