Constipation is common among people with cancer, affecting of those diagnosed. It can be a side effect of treatment, lifestyle or the disease itself, says , a dietitian with the .
Regardless of its cause, constipation affects quality of life, sometimes causing pain, discomfort and even treatment delays if symptoms are too severe to proceed, Washburn says.
The causes and potential remedies for cancer-related constipation are highly individual, she says. It’s not as simple as following online advice. Search “constipation cure,” for example, and you’ll be told to consume more fiber, but that doesn’t work for everyone, Washburn says, and in some cases could be the opposite of what’s needed.
“The recommendations are very personalized and tailored to the individual and all that we know about them,” says Washburn, who is board certified in oncology nutrition. “Oftentimes a multidisciplinary approach works best for managing constipation.”
What is constipation?
The National Institutes of Health defines as infrequent bowel movements and stools that are hard, dry and difficult or painful to pass, but Washburn prefers using more subjective criteria.
“I think constipation is perceived,” she says. “It’s a change in bowel habits that can happen during (the cancer journey) … whether it's defined as constipation or not.”
Causes during cancer treatment
One of the most common culprits of digestive issues is the medication given during cancer treatment. Opioid painkillers and the anti-nausea medications often prescribed to patients undergoing chemotherapy can cause constipation, Washburn says.
Tumors in or near the intestines can affect the movement of food through the digestive tract. Dietary changes – eating different foods or different amounts of food – impact digestion and bowel habits. Reduced physical activity and insufficient fluid intake can also increase the likelihood of constipation.
And the stress of dealing with disease can interfere with digestion by keeping the nervous system in fight-or-flight mode.
“Stress can result in constipation,” Washburn says. “Your parasympathetic nervous system needs to be activated for you to rest and digest your food.”
Combatting constipation
The first thing Washburn does when helping a client with constipation is take a comprehensive look at what and how they’re eating. It’s not just about food choices, she says, but overall eating habits.
How is their food prepared: fried, baked, raw? How quickly or slowly do they eat? Do they consume large meals? Do they eat while standing up or multitasking?
Washburn also wants to know how an individual is sleeping and moving, as well as learn of any previous conditions, treatments or diagnoses that might affect digestion and elimination.
Based on this information, she’ll offer tailored recommendations that may include:
- Increasing fluid intake: “Warm fluids may stimulate that parasympathetic nervous system better, which may help with peristalsis, or the movement of food down the GI tract,” Washburn says.
- Eating more cooked foods: “Some people need to eat more cooked foods than raw foods,” she says. “Your body has to do less processing to cooked foods because the heat of cooking it does the processing for you.”
- Eating smaller, more frequent meals: “Too much food at once can make things go down slower,” she says.
- Moving and twisting the waist, if possible, to stimulate peristalsis
- Supplementing with magnesium
More fiber isn’t always the answer, she emphasizes. For constipation related to chemotherapy, fiber may not be helpful, she says. And for people with narrowing of the intestines, more fiber could potentially exacerbate bowel issues.
“Fiber adds volume and bulk to the stool,” she says, “which may prevent it from passing through these narrow areas, worsening constipation or creating a bowel obstruction.”
Multidisciplinary solutions
While Washburn begins with nutrition to help people manage constipation, she also works with a patient’s care team to develop multidisciplinary solutions. Doctors may prescribe laxatives or other medications to facilitate bowel movements.
Washburn advises patients experiencing constipation to discuss their symptoms with their dietitian or care team.
“Our goal is to help minimize side effects such as constipation, to maximize health and well-being during cancer treatment. We are here to help patients use food and nutrition to navigate through their treatment."
