Managing Cancer-related Constipation: A Whole Person Approach - CancerChoices



Managing Cancer-related Constipation: A Whole Person Approach

Constipation at a glance

Constipation is a common symptom experienced by people with cancer. Some cancer treatments and medications can contribute to this condition, as can inactivity, inadequate fluid and fiber intake, and even emotions such as depression and anxiety. Understanding complementary therapies and lifestyle practices that can alleviate constipation symptoms can be helpful for improving your quality of life. 

On this page

Constipation: an overview ›

Top evidence-based practices and therapies for managing constipation ›

Helpful links ›

Constipation: an overview

What is constipation?

Constipation refers to difficulty in having bowel movements or having them less frequently than usual.

Fecal impaction is a serious problem when constipation is unmanaged. “A fecal impaction is a large lump of dry, hard stool that stays stuck in the rectum. It is most often seen in people who are constipated for a long time.”1Fecal impaction. MedlinePlus Medical Encyclopedia. December 31, 2023. Viewed October 23, 2024 Discuss with your practitioner if you experience any of these with chronic (long-term) constipation: 

  • Abdominal cramping and bloating
  • Leakage of liquid or sudden episodes of watery diarrheas 
  • Rectal bleeding
  • Small, semi-formed stools
  • Straining when trying to pass stools

What can cause or trigger constipation?

Constipation can be caused by various factors, including medications commonly used during cancer treatment and some lifestyle practices.2Constipation. Johns Hopkins Medicine. Viewed August 27, 2024; Constipation. American Cancer Society. Viewed August 27, 2024.

  • Medications
    • Some chemotherapy drugs, such as vincristine
    • Immunomodulatory medicines such as thalidomide, lenalidomide, and pomalidomide
    • Opioids, antidepressants, and the contrast used for CT and MRI scans 
  • Lack of exercise
  • Not enough liquids
  • Not enough dietary fiber
  • Irritable bowel syndrome
  • Ignoring the urge to have a bowel movement
  • Overuse of laxatives
  • Depression3Wang P, Shen X, Wang Y, Jia X. Association between constipation and major depression in adult Americans: evidence from NHANES 2005-2010. Frontiers in Psychiatry. 2023 Aug 15;14:1152435.
  • Anxiety/stress4Hosseinzadeh ST, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterology and Hepatology from Bed to Bench. 2011 Summer;4(3):159-63.

What are signs and symptoms of constipation?

Consult your doctor if you are experiencing abdominal pain or are experiencing continued constipation. 

  • Difficult and painful bowel movements
  • Fewer than 3 bowel movements a week
  • Bloating or abdominal discomfort

Top evidence-based practices and therapies for managing constipation 

We present approaches to managing constipation backed by modestsignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently), goodsignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently), or strongconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) evidence of effectiveness.

Conventional therapies

Stool softeners, fiber supplements, and laxatives are often prescribed for people with constipation. The American Cancer Society advises that “laxatives can be habit-forming and shouldn’t be used long-term. Always check with your doctor or cancer care team before starting a laxative, even if they’re over the counter.”5Constipation. American Cancer Society. April 22, 2024. Viewed August 28, 2024.

Over-the-counter laxatives (not needing a prescription) work in different ways:6Laxatives. Cleveland Clinic. July 10, 2023. Viewed October 10, 2024. 

  • Bulk-forming laxatives such as Metamucil® add fiber to your digestive tract to stimulate bowel movements. Psyllium, the active ingredient in many bulk laxatives, can be purchased as a supplement.
  • Osmotic laxatives such as Gavilax®, Ex-Lax®, or Phillips’® Milk of Magnesia pull water from other body parts and send it to your colon. Various forms of magnesium—magnesium oxide, magnesium citrate, or magnesium hydroxide—are the active ingredient in some osmotic laxatives and can be purchased as supplements.
  • Stool softeners such as Colace® increase the water and fat your stool absorbs. If the muscles in your bowel are not moving the stool forward and out of the colon, which is common with constipation caused by opioids, usually a stool softener alone will not relieve your constipation.
  • Lubricant laxatives such as mineral oil coat your colon, making it slick.
  • Stimulant laxatives such as Dulcolax® activate the nerves that control the muscles in your colon. Senna, the active ingredient in some stimulant laxatives, can be purchased as a supplement.

If these laxatives are not effective, prescription medications are available. If you are in active cancer treatment, have an ongoing health condition, have moderate or severe abdominal pain, or are still not able to have a bowel movement within three days of taking any of the laxatives above, contact your healthcare practitioner.

Lifestyle practices

Complementary therapies 

  • Acupressure involves applying pressure to specific places on your body. For people with cancer, acupressure at targeted points has been shown to provide relief from constipation, including constipation related to opioid use.13Hepp N. How can acupressure help you? What the research says. CancerChoices. August 27, 2024. See Acupressure: affordability and access › 
  • Acupuncture involves inserting fine needles into specific points on the body. People with cancer who receive acupuncture often experience relief from constipation, including after surgery and during chemotherapy.14Hepp N. How can acupuncture help you? What the research says. CancerChoices. August 28, 2024. Acupuncture at specific points for each of the four patterns of constipation are recommended in a practice guideline from Hong Kong.15Lam WC, Zhong L et al. Hong Kong Chinese Medicine clinical practice guideline for cancer palliative care: pain, constipation, and insomnia. Evidence-Based Complementary and Alternative Medicine. 2019 Jan 22;2019:1038206. See Acupuncture: affordability and access ›
  • Electroacupuncture involves inserting very thin needles at specific points on the body and passing a mild electric current between them. People with cancer treated with electroacupuncture have experienced less constipation in several studies.16Hepp N, Pole L. How can electroacupuncture help you? What the research says. CancerChoices. August 28, 2024. See Electroacupuncture: affordability and access ›
  • Probiotics are living microorganisms that are available in many foods, such as yogurt, or as supplements. Prebiotics are fibers that feed these friendly bacteria. People with cancer treated with probiotics, sometimes also with prebiotics, have experienced less constipation in several studies.17Hepp N, Jackson A. How can probiotics and prebiotics help you? What the research says. CancerChoices. August 28, 2024. See Probiotics and Prebiotics: affordability and access ›
  • Yoga is an ancient mind-body practice combining movement and stretches with meditation. People with cancer practicing yoga have experienced less constipation in several studies.18Hepp N, Pole L. How can yoga help you? What the research says. CancerChoices. August 28, 2024. See Yoga: affordability and access ›

Traditional Chinese medicine uses herbal mixtures specific to each of the four patterns of constipation. These are recommended in a practice guideline from Hong Kong.19Lam WC, Zhong L et al. Hong Kong Chinese Medicine clinical practice guideline for cancer palliative care: pain, constipation, and insomnia. Evidence-Based Complementary and Alternative Medicine. 2019 Jan 22;2019:1038206. See Traditional Chinese Medicine and Professionals in Cancer Care › and Table 6 of Hong Kong Chinese Medicine clinical practice guideline for cancer palliative care: pain, constipation, and insomnia › 

Helpful links

Authors

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Christine Mineart, MPH

CancerChoices Program Director
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Christine has a dynamic background in the life sciences, public health, and program operations. Her career began at the lab bench with a Gates Foundation-funded HIV Vaccine research group, which led her to graduate studies in public health epidemiology at UC Berkeley. Her research experience spans clinical epidemiology research to evaluating the impacts of community nutrition programs in Los Angeles, the Central Valley, and Oakland. Most recently she has worked in executive operations for a seed-stage venture capital firm based in San Francisco. Personally, Christine is passionate about holistic health and wellness. She is a clinical herbalist and Reiki master, and she has been practicing yoga for 15+ years. She brings a breadth of experiences to her work leading the CancerChoices program.

Christine Mineart, MPH CancerChoices Program Director

Reviewer

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Last update: November 4, 2024

Last full literature review: November 2024

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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