Letters from Our Readers
September 08, 2008
Web Exclusive: For the Caregiver: How to Make the Adjustment Post-Treatment
September 08, 2008 – Charlotte Huff
Defeating Fear: Strategic Moves
September 08, 2008 – Paul Engstrom
Scott's Denial
September 08, 2008 – Tara Beers Gibson, PhD
Planning for Survivorship
September 08, 2008 – Kathy LaTour
Re-Entry: Age & Gender
September 08, 2008 – Charlotte Huff
Web Exclusive: How to Manage Side Effects
September 08, 2008
Web Exclusive: Preventing Breast Cancer
September 08, 2008
Breaking Down TCM
September 08, 2008 – Lena Huang
When Patients Don't Want to Know
September 08, 2008 – Joanne Kenen
Survivors Celebrate and Stroll
September 08, 2008 – Lena Huang
Active Recovery
September 08, 2008 – Don Vaughan
Challenges in Cancer Survivorship
September 08, 2008 – Kathy LaTour
Back to 'Normal'
September 08, 2008 – Charlotte Huff
Web Exclusive: Questions to Ask Your Doctor
September 08, 2008
What's the Right Decision?
September 08, 2008 – Jeffrey Belkora, PhD
Multiple Myeloma & Thrombocytopenia
September 08, 2008 – Elizabeth Whittington
The Last Tenth
September 08, 2008 – Jen Hoffmann
Keep It Moving
September 08, 2008 – Lacey Meyer
Glossary: Making Sense of the Jargon
September 08, 2008 – Katy Human
Surgery & Radiation: New Options, New Questions
September 08, 2008 – Katy Human
To Take or Not to Take
September 08, 2008 – Lena Huang
Finding Your Compass
September 08, 2008 – Katy Human
Pretty Is What Changes
September 08, 2008 – Kathy LaTour
Dana Farber's Survivorship Clinic
September 08, 2008 – Elizabeth Whittington
Programs to Help People Quit Smoking Miss Minorities
September 08, 2008 – Elizabeth Whittington
New Funding and a New Voice
September 08, 2008 – Elizabeth Whittington
Advocating for Others
September 08, 2008 – Lacey Meyer
Never Fear
September 08, 2008 – Paul Engstrom
Q&A: Vitamin D
September 08, 2008 – Len Lichtenfeld, MD
www.SharingHope.tv
September 08, 2008 – Elizabeth Whittington
New Pharmacy Breed Offers Special Attention, Drawbacks to Patients
September 08, 2008 – Jessica Wapner
Olympian Postpones Treatment to Compete
September 08, 2008 – Elizabeth Whittington
International Thyroid Cancer Survivors' Conference
September 08, 2008 – Elizabeth Whittington
Understanding Preventive Mastectomy
September 08, 2008 – Kathy LaTour
New Law Prevents Genetic Discrimination
September 08, 2008 – Elizabeth Whittington
East Meets West
September 08, 2008 – Lena Huang
Facing A Legacy
September 08, 2008 – Kathy LaTour
What to Know Before You Go
September 08, 2008 – Susan Kreimer
Far From Home
September 08, 2008 – Susan Kreimer
Message from the CURE Staff
September 08, 2008 – The CURE Team
Letters from Our Readers
September 08, 2008
Web Exclusive: For the Caregiver: How to Make the Adjustment Post-Treatment
September 08, 2008 – Charlotte Huff
Defeating Fear: Strategic Moves
September 08, 2008 – Paul Engstrom
Scott's Denial
September 08, 2008 – Tara Beers Gibson, PhD
Planning for Survivorship
September 08, 2008 – Kathy LaTour
Re-Entry: Age & Gender
September 08, 2008 – Charlotte Huff
Web Exclusive: How to Manage Side Effects
September 08, 2008
Web Exclusive: Preventing Breast Cancer
September 08, 2008
Breaking Down TCM
September 08, 2008 – Lena Huang
When Patients Don't Want to Know
September 08, 2008 – Joanne Kenen
Survivors Celebrate and Stroll
September 08, 2008 – Lena Huang
Active Recovery
September 08, 2008 – Don Vaughan
Challenges in Cancer Survivorship
September 08, 2008 – Kathy LaTour
Back to 'Normal'
September 08, 2008 – Charlotte Huff
Web Exclusive: Questions to Ask Your Doctor
September 08, 2008
What's the Right Decision?
September 08, 2008 – Jeffrey Belkora, PhD
Multiple Myeloma & Thrombocytopenia
September 08, 2008 – Elizabeth Whittington
The Last Tenth
September 08, 2008 – Jen Hoffmann
Currently Viewing
Keep It Moving
September 08, 2008 – Lacey Meyer
Surgery & Radiation: New Options, New Questions
September 08, 2008 – Katy Human
To Take or Not to Take
September 08, 2008 – Lena Huang
Finding Your Compass
September 08, 2008 – Katy Human
Pretty Is What Changes
September 08, 2008 – Kathy LaTour
Dana Farber's Survivorship Clinic
September 08, 2008 – Elizabeth Whittington
Programs to Help People Quit Smoking Miss Minorities
September 08, 2008 – Elizabeth Whittington
New Funding and a New Voice
September 08, 2008 – Elizabeth Whittington
Advocating for Others
September 08, 2008 – Lacey Meyer
Never Fear
September 08, 2008 – Paul Engstrom
Q&A: Vitamin D
September 08, 2008 – Len Lichtenfeld, MD
www.SharingHope.tv
September 08, 2008 – Elizabeth Whittington
New Pharmacy Breed Offers Special Attention, Drawbacks to Patients
September 08, 2008 – Jessica Wapner
Olympian Postpones Treatment to Compete
September 08, 2008 – Elizabeth Whittington
International Thyroid Cancer Survivors' Conference
September 08, 2008 – Elizabeth Whittington
Understanding Preventive Mastectomy
September 08, 2008 – Kathy LaTour
New Law Prevents Genetic Discrimination
September 08, 2008 – Elizabeth Whittington
East Meets West
September 08, 2008 – Lena Huang
Facing A Legacy
September 08, 2008 – Kathy LaTour
What to Know Before You Go
September 08, 2008 – Susan Kreimer
Far From Home
September 08, 2008 – Susan Kreimer
Message from the CURE Staff
September 08, 2008 – The CURE Team

Keep It Moving

Constipation during treatment can be alleviated.

BY Lacey Meyer
PUBLISHED September 08, 2008

Suffering from constipation is no longer an accepted part of cancer treatment. Whether it’s a side effect of chemotherapy or opioids (narcotic medications) used to treat cancer-related pain, today there are many ways to alleviate constipation without interfering with cancer treatment or pain relief.  

CAUSES > Constipation results when stools stay in the bowel too long, becoming dry and difficult to pass. Some classes of chemotherapy drugs, such as vinca alkaloids, taxanes, and platinum agents, affect the nerve supply to the bowel and slow down the natural movement and rhythm of the intestines in addition to affecting appetite and normal physical activity abilities.

Up to 90 percent of cancer patients experience cancer-related pain, and opioids, such as morphine, hydrocodone (Vicodin, Lortab) and oxycodone (Percocet, OxyContin), frequently cause constipation. Opioids effectively relieve pain by binding to certain receptors in the brain and spinal cord, but they also bind to receptors found in the intestines, leading to constipation in about half of patients by disrupting contractions that help move stools downward. Without contractions, stools stay in the intestines longer and become dry and hard as the body reabsorbs the water.

MANAGEMENT > Constipation is one of the most common and debilitating side effects in patients taking opioids, and since constipation can be predicted, a bowel regimen should always begin at the same time as opioid use.

Several over-the-counter medications are available, including stimulant laxatives Senokot (senna) and Dulcolax (bisacodyl), which increase contractions in the bowel; stool softeners, such as Colace and Surfak (docusate), which help retain water in the bowel to soften the stool; and osmotic laxatives, such as lactulose, which use osmosis to pull water into the intestines.

To achieve optimum results, a stimulant is typically given with a stool softener to move the stool through the intestines before the body reabsorbs the water. Studies show it is unlikely that stimulant laxative use at the recommended dose will cause dependency. In addition, there is no risk of so-called rebound constipation after stopping laxative intake, according to research published in The American Journal of Gastroenterology.

In April, the Food and Drug Administration approved Relistor (methylnaltrexone) to treat opioid-induced constipation in patients with late-stage, advanced illnesses, including cancer, AIDS, and lung disease. Relistor, which is given by subcutaneous injection (under the skin), blocks the opioid receptor in the gastrointestinal tract but because it cannot cross the blood-brain barrier it does not interfere with opioids’ pain-relieving properties housed in the brain. Relistor is the first drug approved for opioid-induced constipation, and studies for this indication are under way with similar agents, including Entereg (alvimopan), oral PEG-Naloxol, and Naloxone.

PREVENTION > In addition to doctor-recommended medications, prevention strategies should be utilized as much as possible to promote regular bowel movement and function. Eating high-fiber foods such as beans, peaches, squash, broccoli, carrots, and whole-grain bread and bran can minimize constipation because fiber helps to hold water in the stool, making it heavier and able to move through the intestines faster.

Experts recommend 20 to 35 grams of fiber per day, but this should be accompanied by sufficient amounts of non-caffeinated fluid because fiber without enough fluids can result in hard, dry stools. Some fiber preparations cause gas, so patients can experiment with different fiber products or use antigas medications such as simethicone.

The recommended 30 minutes of moderate exercise each day not only helps to stay in shape, but also serves as a preventive measure for cancer patients at an increased risk of constipation. Physical activity helps move food through the bowels, while lack of activity can slow food by reducing muscle contractions in the intestines and abdomen.

Be the first to discuss this article on CURE's forum. >>
Talk about this article with other patients, caregivers, and advocates in the General Discussions CURE discussion group.

Related Articles

1
×

Sign In

Not a member? Sign up now!
×

Sign Up

Are you a member? Please Log In