Constipation in palliative care

Constipation can be different for everyone. Generally, constipation can mean:

• a change in your usual bowel movement pattern
• hard or lumpy bowel movements
• difficulty passing bowel movements or straining
• gas, wind, bloating or stomach cramps and discomfort
• the feeling of being unable to completely empty your bowel
• the feeling that there is something blocking your bowel.

The feeling of being constipated can be distressing and can cause symptoms such as:

• nausea and vomiting
• stomach pain and bloating
• overflow diarrhoea
• loss of appetite
• anxiety and confusion 
• bowel obstruction (your bowel is blocked).

Constipation near the end of life often has more than one cause. Common causes include:

• low fibre diet (due to loss of appetite)
• medicines such as opioids, antimuscarinics, ondansetron, iron, anti-cancer drugs and Parkinson's medications
• metabolic causes such as high blood calcium (hypercalcaemia)
• dehydration
• bowel obstruction (your bowel is blocked) due to stools, tumours or adhesions from surgery
• immobility (not moving for a long period of time)
• neurological disorders such as spinal cord compression
• other existing medical conditions such as hypothyroidism, diabetes, haemorrhoids or anal fissure.

Your doctor may ask you some questions to find out the possible causes of your constipation. They may do a physical examination, including a rectal examination, to check for signs of illness or disease. They may also carry out tests, such as blood and urine tests, to rule out physical causes.

Treatment of constipation depends on the cause of your constipation. If you have a medical condition or any obvious causes of constipation are found, treatment will focus on the condition or cause. If you are on a medicine that can cause constipation, your doctor may ask you to stop taking the medicine. 

Medicines

Laxatives are used to treat constipation. Different types of laxatives work in different ways to one another. The choice of medicine will depend on what has caused your constipation. You may need more than one type of laxative. 

Common laxatives that may be prescribed include:

• macrogols
• docusate sodium
• sennoside B
• bisacodyl
• senna.

Some of these medicines can be taken by mouth. Others are taken as a suppository or an enema inserted in your bottom. Read more about laxatives. 

There are several things you can do to help manage constipation. These include the following:

• Drink more fluids.
• Eat regular meals and increase fibre intake, such as eating more fruit and vegetables, beans, wholegrains and cereals.
• Try natural laxatives such as dried fruits, prunes and apricots.
• Be active if possible.
• Make sure it is easy for you to go to the toilet and that you have enough privacy in the toilet.
• Make sure you take your laxatives regularly if prescribed by a doctor.
• Massage your tummy to encourage bowel movements.
• Keep track of and review your symptoms regularly.
• Contact your healthcare providers if your symptoms don't improve. 

People living with constipation can feel distressed and have reduced quality of life. Talk through your feelings with your family and friends to get the support you need. 

Below are some support services and information for people affected by cancer and their family/whānau:

Emotions and cancer(external link) Cancer Society of NZ
How we can help(external link) Cancer Society of NZ
NZ cancer services – find a hospital/service near you(external link) Healthpoint, NZ
More cancer support groups