Constipation during Cancer Therapy
There are many reasons for constipation (decrease in normal bowel movement) during chemotherapy.
The intestine’s natural rhythm can be slowed down by some chemotherapy drugs and pain medication, or by vomiting, decreased activity, or eating and drinking less.
This causes infrequent bowel movements with hard, dry stools.
You can do many things to prevent or relieve constipation during treatment. Your child’s doctor can recommend medications if the following home remedies are not effective on their own.
Follow the instructions enclosed with any prescribed medication. Check with the doctor before using any over-the-counter medicines.
Enemas, Suppositories and Laxatives
Do not use enemas or rectal suppositories as these risk of anal tears. In immune compromised children this can cause infections, which may disrupt treatment.
Do not use a laxative without consulting your child’s doctor. These can interfere with the body’s ability to absorb vitamin D and calcium (vital to developing strong bones), and may strip the body of important electrolytes. Only use a laxative prescribed by the doctor.
Food and Drink
Serve foods high in fibre as these increase intestinal activity. Good sources of fibre include:
- Fresh and dried fruits (such as plums, prunes, pears, dates and raisins).
- Raw and cooked vegetables.
- Beans, nuts and popcorn.
- Breakfast cereals such as Weetabix®, Shredded Wheat®, muesli and bran flakes.
- Wholemeal bread, crackers and flour.
- Brown rice and wholemeal pasta.
Serve lots of fluids (water and juices), and encourage your child to drink as much as possible every day. This is particularly important if you increase the amount of fibre in your child’s diet, as eating fibre without drinking enough fluids makes constipation worse.
Prune and plum juice are particularly helpful.
Avoid carbonated beverages as they can increase dehydration.
The table below shows appropriate fluid intake for young children.
|Child’s Age||Adequate Total Daily Fluid Intake|
|0–6 Months||0.7 L, including human milk or formula.|
|7–12 Months||0.8 L, including approximately 0.6 L (3 cups) as formula or human milk, juices, and drinking water.|
|1–3 Years||1.3 L, including approximately 0.9 L (4 cups) as beverages, including drinking water.|
|4–8 Years||1.7 L, including approximately 1.2 L (5 cups) as beverages, including drinking water.|
Encourage your child to move about as much as possible as physical activity stimulates the intestine. Aim for 20-30 minutes of gentle exercise most days of the week. Walking, crawling, gentle baby gym and regular active play are all effective.
Talk with your child’s doctor about what kind of exercise and how much exercise will be acceptable and helpful during chemotherapy.
Schedule time each day for a bowel movement. Creating a daily routine may help your child. Choose a time when you are not in a hurry. Take your time and help your child to relax.
Sipping a warm drink during bowel movements can help ease the process, so prepare your child’s favourite warm drink for this time as a special treat.
Seek Medical Advice
Consult your child’s doctor before attempting to treat constipation with medication. A prescription drug may be better than over-the-counter options.
Contact the doctor if one or more of the following symptoms occur.
- Constipation continues after 3 days of home treatment.
- Developing or increasing rectal pain.
- Blood in the stool.
- Belly pain or fever.
- Uncontrolled leakage of stool.
- Inability to pass gas.
- Nausea, and/or vomiting accompanies constipation.
- Stomach looks swollen and/or feels hard to the touch.
Possible medications include stimulants such as Metamucil or Citrucel, stool fluid retainers such as Milk of magnesia or magnesium citrate, or stool softeners such as Colace or ducosate. Many children do not like the taste of liquid ducosate.