 |
[Home] | [Search] | [Medical Q&A Forums] | [Patient Network] |
This information has been brought to you by
Med Help International,
licenced by the National Cancer Institute as a distributor of CancerNet.
CancerMail from the National Cancer Institute
Information from PDQ for Patients
Constipation, impaction, and bowel obstruction
208/03510
** INTRODUCTION **
This patient summary on constipation, impaction, and bowel obstruction is
adapted from a summary written for health professionals by cancer experts.
This and other credible information about cancer treatment, screening,
prevention, supportive care, and ongoing clinical trials, is available from the
National Cancer Institute. Constipation, impaction, and bowel obstruction are
common problems for cancer patients, with causes that include the cancer itself
or treatment of the cancer. This brief summary describes the differences
between constipation, impaction, and bowel obstruction, their causes and
treatment. Treatment of children is different from adults. The doctor will
prescribe treatments according to the child's age and diagnosis.
** OVERVIEW **
Constipation, impaction, and bowel obstruction are common problems for cancer
patients. The growth and spread of cancer, and cancer treatment, contributes
to these conditions.
Constipation is the slow movement of feces (stool or body wastes) through the
large intestine resulting in infrequent bowel movements and the passage of dry,
hard stools. The longer it takes for the stool to move through the large
intestine, the more fluid is absorbed and the drier and harder the stool
becomes.
Constipation is annoying and uncomfortable, but fecal impaction (a collection
of dry, hard stool in the colon or rectum) can be life-threatening. Patients
with a fecal impaction may not have gastrointestinal symptoms. Instead they
may have circulation, heart, or breathing problems. If fecal impaction is not
recognized, the signs and symptoms will get worse and the patient could die.
A bowel obstruction is a partial or complete blockage of the small or large
intestine by a process other than fecal impaction. Bowel obstructions are
classified by the type of obstruction, how the obstruction occurred, and where
it is. Tumors growing inside or outside the bowel, and scar tissue that
develops after surgery, can affect bowel function and cause a partial or
complete obstruction. Patients who have colostomies are especially at risk of
developing constipation, which can lead to bowel obstruction.
Inactivity, immobility, or physical and social barriers (for example, bathrooms
being unavailable or inconveniently located) can make constipation worse.
Depression and anxiety caused by cancer treatment or cancer pain can also lead
to constipation. The most common causes of constipation are not drinking
enough fluids and taking pain medications.
** CONSTIPATION **
-- Description and Causes --
Common factors that may cause constipation in healthy people are eating a
low-fiber diet, postponing visits to the toilet, using laxatives and enemas
excessively, not drinking enough fluids, and exercising too little. In persons
with cancer, constipation may be a symptom of cancer, a result of a growing
tumor, or a result of cancer treatment. Constipation may also be a side effect
of medications for cancer or cancer pain and may be a result of other changes
in the body (organ failure, decreased ability to move, and depression). Other
causes of constipation include dehydration and not eating enough. Cancer,
cancer treatment, aging, and declining health can contribute to causing
constipation.
More specific causes of constipation and bowel impaction include:
Diet
- Not including enough high-fiber foods in the diet
- Not drinking enough water or other fluids
Changed Bowel Habits
- Repeatedly ignoring the urge to pass stool
- Using too many laxatives and enemas
Immobility and Lack of Exercise
- Spinal cord injury, spinal cord compression, bone fractures, fatigue,
weakness, long periods of bedrest
- Inability to tolerate movement and exercise due to respiratory or
cardiac problems
Medications
- Chemotherapy treatments
- Pain medications
- Medications for anxiety and depression
- Stomach antacids
- Diuretics
- Vitamin supplements such as iron and calcium
- Sleep medications
- General anesthesia
Bowel Disorders
- Irritable colon
- Diverticulitis
- Tumor
Muscle and Nerve Disorders (nerve damage can lead to loss of muscle tone
in the bowel)
- Brain tumors
- Spinal cord compression from a tumor or other spinal cord injury
- Stroke or other disorders that cause muscle weakness or movement
- Weakness of the diaphragm or abdominal muscles making it difficult to
take a deep breath and push to have a bowel movement
Body Metabolism Disorders
- Under-secretion of the thyroid gland
- Increased level of calcium in the blood
- Low levels of potassium or sodium in the blood
- Diabetes with nerve dysfunction
Environmental Factors
- Needing assistance to go to the bathroom
- Being in unfamiliar surroundings or a hurried atmosphere
- Living in extreme heat leading to dehydration
- Needing to use a bedpan or bedside commode
- Lack of privacy
-- Assessment of Constipation --
A medical history and physical examination can identify the causes of
constipation. The examination may include a digital rectal exam (the doctor
inserts a gloved, lubricated finger into the rectum to check for stool
impaction) or a test for blood in the stool. If cancer is suspected, a
thorough examination of the rectum and colon may be done with a lighted tube
inserted through the anus and into the colon. The following questions may be
asked:
- What is your normal bowel pattern? How often do you have a bowel
movement? When and how much?
- When was your last bowel movement? What was it like (how much, hard or
soft, color)? Was there any blood?
- Has your stomach hurt or have you had any cramping, nausea, vomiting,
pain, gas, or feeling of fullness near the rectum?
- Do you use laxatives or enemas regularly? What do you normally do to
relieve constipation? Does this usually work?
- What kind of food do you eat? How much and what type of fluids do you
drink daily?
- What medicine are you taking? How much and how often?
- Is this constipation a recent change in your normal habits?
- How many times a day do you pass gas?
-- Treatment --
Treatment of constipation includes prevention (if possible), elimination of
possible causes, and limited-use of laxatives. Suggestions for the patient's
treatment plan may include the following:
- Keep a record of all bowel movements.
- Increase the fluid intake by drinking eight 8-ounce glasses of fluid
each day (if not contraindicated by kidney or heart disease).
- Exercise regularly, including abdominal exercises in bed or moving from
the bed to chair if the patient cannot walk.
- Increase the amount of dietary fiber by eating more fruits (raisins,
prunes, peaches, and apples), vegetables (squash, broccoli carrots, and
celery), and whole grain cereals, breads, and bran. Patients must drink
more fluids when increasing dietary fiber or they may become
constipated. Patients who have had a bowel obstruction or have undergone
bowel surgery (for example, a colostomy) should not eat a high-fiber diet.
- Drink a warm or hot drink about one half-hour before the patient's usual
time for a bowel movement.
- Provide privacy and quiet time when the patient needs to have a bowel
movement.
- Help the patient to the toilet or provide a bedside commode instead of a
bedpan.
- Take only medications prescribed by the doctor.
- Do not use suppositories or enemas unless ordered by the doctor. In
some cancer patients these treatments may lead to bleeding, infection,
or other harmful side effects.
** IMPACTION **
-- Description and Causes --
Five major factors can cause impaction: opioid pain medications, inactivity
over a long period, changes in diet, mental illness, and long-term use of
laxatives. Regular use of laxatives for constipation contributes most to the
development of constipation and impaction. Repeated use of laxatives in higher
and higher doses make the colon less able to signal the need to have a bowel
movement.
Patients with impaction may have symptoms similar to patients with
constipation, or they may have back pain (the impaction presses on sacral
nerves) or bladder problems (the impaction presses on the ureters, bladder, or
urethra). The patient's abdomen may become enlarged causing difficulty
breathing, rapid heartbeat, dizziness, and low blood pressure. Other symptoms
can include explosive diarrhea (as stool moves around the impaction), leaking
stool when coughing, nausea, vomiting, abdominal pain, and dehydration.
Patients who have an impaction may become very confused and disoriented with
rapid heartbeat, sweating, fever, and high or low blood pressure.
-- Assessment of Impaction --
The doctor will ask questions similar to those in the "Assessment of
Constipation" section and do a physical examination to find out if the patient
has an impaction. The examination may also include x-rays of the abdomen
and/or chest, blood tests, and an electrocardiogram (a test that shows the
activity of the heart).
-- Treatment of Impaction --
Impactions are usually treated by moistening and softening the stool with an
enema. Enemas must be given very carefully as prescribed by the doctor since
too many enemas can damage the bowel. Some patients may need to have stool
manually removed from the rectum after it is softened. Glycerin suppositories
may also be prescribed. Laxatives that stimulate the bowel and cause cramping
must be avoided since they can damage the bowel even more.
** BOWEL OBSTRUCTION **
-- Description and Causes --
A bowel obstruction may be caused by a narrowing of the intestine from
inflammation or damage to the bowel, tumors, scar tissue, hernias, twisting of
the bowel, or pressure on the bowel from outside the intestinal tract. It can
also be caused by factors that interfere with the function of muscles, nerves,
and blood flow to the bowel. Most bowel obstructions occur in the small
intestine and are usually caused by scar tissue or hernias. The rest occur in
the colon (large intestine) and are usually caused by tumors, twisting of the
bowel, or diverticulitis. Symptoms will vary depending on whether the small or
large intestine is involved.
The most common cancers that cause bowel obstructions are cancers of the colon,
stomach, and ovary. Other cancers, such as lung and breast cancers and
melanoma, can spread to the abdomen and cause bowel obstruction. Patients who
have had abdominal surgery or radiation are at a higher risk of developing a
bowel obstruction. Bowel obstructions are most common during the advanced
stages of cancer.
-- Assessment of Bowel Obstruction --
The doctor will do a physical examination to find out whether the patient has
abdominal pain, vomiting, or any movement of gas or stool in the bowel. Blood
and urine tests may be done to detect any fluid and blood chemistry imbalance
or infection. Abdominal x-rays and a barium enema may also be done to find the
location of the bowel obstruction.
-- Treatment of Acute Bowel Obstruction --
Patients who have abdominal symptoms that continue to become worse must be
monitored frequently to prevent or detect early signs and symptoms of shock and
constricting obstruction of the bowel. Medical treatment is necessary to
prevent fluid and blood chemistry imbalances and shock.
A nasogastric tube may be inserted through the nose and esophagus into the
stomach or a colorectal tube may be inserted through the rectum into the colon
to relieve pressure from a partial bowel obstruction. The nasogastric
tube or colorectal tube may decrease swelling, remove fluid and gas build-up,
or decrease the need for multiple surgical procedures; however, surgery may be
necessary if the obstruction completely obstructs the bowel.
-- Treatment of Chronic, Malignant Bowel Obstruction --
Patients who have advanced cancer may have chronic, worsening bowel obstruction
that cannot be removed with surgery. Sometimes, the doctor may be able to
insert an expandable metal tube called a stent into the bowel to open the area
that is blocked.
When neither surgery nor a stent is possible, the doctor may insert a
gastrostomy tube through the wall of the abdomen directly into the stomach by a
very simple procedure. The gastrostomy tube can relieve fluid and air build-up
in the stomach and allow medications and liquids to be given directly into the
stomach by pouring them down the tube. A drainage bag with a valve may also be
attached to the gastrostomy tube. When the valve is open, the patient may be
able to eat or drink by mouth without any discomfort because the food drains
directly into the bag. This gives the patient the experience of tasting the
food and keeping the mouth moist. Solid food should be avoided because it may
block the tubing to the drainage bag.
If the patient's comfort is not improved with a stent or gastrostomy tube, and
the patient cannot take anything by mouth, the doctor may prescribe injections
or infusions of medications for pain and/or nausea and vomiting.
** TO LEARN MORE **
Call
For more information, U.S. residents may call the National Cancer Institute's
(NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing
callers with TTY equipment may call 1-800-332-8615. The call is free and a
trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov) provides online access to
information on cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and their families. There
are also many other places where people can get materials and information about
cancer treatment and services. Local hospitals may have information on local
and regional agencies that offer information about finances, getting to and
from treatment, receiving care at home, and dealing with problems associated
with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals,
and the public. These publications discuss types of cancer, methods of cancer
treatment, coping with cancer, and clinical trials. Some publications provide
information on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on these and other
topics may be ordered online or printed directly from the NCI Publications
Locator (http://cissecure.nci.nih.gov/ncipubs). These materials can also be
ordered by telephone from the Cancer Information Service toll-free at
1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with an
Information Specialist. The service is available from 9:00 a.m. to 7:30 p.m.
Eastern time, Monday through Friday. Information Specialists can help Internet
users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
** ABOUT PDQ **
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information
database. Most of the information contained in PDQ is available online at
Cancer.gov (http://cancer.gov), the NCI's Web site. PDQ is provided as a
service of the NCI. The NCI is part of the National Institutes of Health, the
federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on
cancer prevention, detection, genetics, treatment, supportive care, and
complementary and alternative medicine. Most summaries are available in two
versions. The health professional versions provide detailed information
written in technical language. The patient versions are written in
easy-to-understand, non-technical language. Both versions provide current and
accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and
reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are
responsible for writing and maintaining the cancer information summaries. The
summaries are reviewed regularly and changes are made as new information
becomes available. The date on each summary ("Date Last Modified") indicates
the time of the most recent change.
PDQ also contains information on clinical trials.
Some patients have symptoms caused by cancer treatment or by the cancer itself.
Patients who have symptoms related to cancer treatment may want to take part in
a clinical trial. A clinical trial is a study to answer a scientific question,
such as whether one method of treating symptoms is better than another. Trials
are based on past studies and what has been learned in the laboratory. Each
trial answers certain scientific questions in order to find new and better ways
to help cancer patients. During supportive care clinical trials, information
is collected about new treatment methods, the risks involved, and how well they
do or do not work. If a clinical trial shows that a new treatment is better
than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at
Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are
available in health professional and patient versions. Many cancer doctors who
take part in clinical trials are also listed in PDQ. For more information,
call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
Date Last Modified: 06/2002
******************************************************************************
* If you want to know more about cancer and how it is treated, or if you *
* if you wish to know about clinical trials for your type of cancer, you *
* can call the NCI's Cancer Information Service at 1-800-422-6237, toll *
* free. A trained information specialist can talk with you and answer *
* your questions. *
******************************************************************************
|
[Home] | [Search] | [Medical Q&A Forums] | [Patient Network] |
This information has been brought to you by
Med Help International,
licenced by the National Cancer Institute as a distributor of CancerNet.