Easing Constipation in Cancer Care

While it may not be discussed very often, constipation can be a very unpleasant side effect of cancer treatment. Opiate pain relievers, reduced activity, changing eating patterns, reduced fluid intake and chemotherapy can all lead to and exacerbate constipation. Diet and lifestyle can play a role in relieving this discomfort. It is also important to discuss this and other possible side effects with your doctor to be proactive about avoiding as many side effects as possible.

Constipation can be a troubling side effect of cancer treatment so it’s important to include lots of foods that can help to relieve those symptoms and help you feel more comfortable through your healing journey. This condition can absolutely get in the way of you meeting your nutritional needs because it often causes people to lose their appetite and avoid eating. It can become painful and uncomfortable and so talking to your medical team as well as having a great dietitian on board with you on your journey is key. It’s important to be proactive here and not let constipation get in your way.

Fiber rich foods

One way to help alleviate constipation is to focus on high fiber foods. There are two kinds of fiber that are important for gut health.

Soluble fiber dissolves in water, this makes a kind of gel and slows down digestion and helps keep your gut healthy. Insoluble fiber does not absorb water, but does feed healthy gut bacteria (you may have heard about your microbiome, this is it) and helps waste move through and out of your body improving constipation.

Good sources of soluble fiber can be found in fruits, nuts, seeds and beans. Insoluble fiber is abundant in vegetables, whole grains and wheat bran.

Prunes are a rich source of both soluble and insoluble fiber that aids in bulking up stool and helping it pass more easily. Prunes and prune juice are also a rich source of sorbitol, a sugar alcohol that acts as a natural laxative. Prunes can be eaten as they are, or you can mix them in your breakfast cereal or with nuts and other dried fruits for a healthy trail mix.

Foods with high water content like pears can help relieve digestion and constipation. Many fruits are high in water content and fiber. For example, pears contain fiber and sorbitol that help to lessen constipation, the majority of the fiber is found in the skin so enjoy your pears with the skin on. Citrus fruits contain abundant fiber as well as pectin (especially in the pith, the white part of the peel) which is also helpful in relieving constipation. Research is being conducted on a specific compound found in oranges, a flavonoid called naringenin, for its potential to act as a laxative and relieve constipation. Orange juice with pulp is a source of fiber, too.

Fruits can be eaten raw as a snack, added to oatmeal, made into a healthy cobbler or chopped up in salads to add a sweet element. Many fruits have high water content, so this can be a tasty way to get more fluids in your diet without having to drink a bunch more liquids. There is some chatter about limiting fruit due to “sugar content” but please keep in mind that fruit isn’t innately ‘sugary’ and has no added sugars, ever. Fruit is actually relatively low glycemic, high in fiber, water, and nutrients your body needs.

Spinach and other greens are another rich source of fiber to add to your diet. Just 1 cup of cooked spinach contains 4g of fiber, about 17% of the recommended daily value for fiber. It’s also high in magnesium that draws water into the colon and acts as a laxative. One cup of cooked spinach contains 50% of the daily recommended magnesium.

Fluids

Adequate fluid intake is very important during cancer treatment. Treatment and side effects such as fever and diarrhea can increase fluid needs and often side effects from treatments. Besides the usually unhelpful advice to “just drink more water” you can try to find things that help you get more fluids. Some ideas include:

• Find some fancy non-alcoholic drinks to make including: infused sparkling or flat water, basically just adding fruits, herbs (think mint), or a splash or juice to water.

• Find some teas that are tasty, there are many options such as mint, cinnamon, chamomile as well as green, black and white tea. Additionally, there are teas to help with relaxation, stomach easing teas, teas especially for constipation or sleep. Try some out and see if any work for you.

• Eat more plants: fruits and vegetables have high water content which helps count towards your daily intake.

Lifestyle

Your lifestyle can have a dramatic effect on how our whole body functions. Movement, stress and sleep have impacts on all facets of our health including our bathroom habits.

• Exercise: Getting some movement in, whether it’s a 45 minute walk outside or 5 minutes of breath work can be helpful in increasing circulation and helping get your body moving. Energy during cancer treatment can be difficult, but focusing on movements that feel good is important for all aspects of health, so try to find some things that are rejuvenating for the days when your energy is low.

• Stress: You may notice that stress can make your muscles tight and contribute to pain. Stress can set off the “fight or flight” reflex that works in opposition to “rest & digest” that helps your body digest food, repair itself and all the body functions that get put on hold when we are facing danger. Finding ways to reduce stress not only helps with constipation, but general health during treatment. Be sure to find something you enjoy, that is the most beneficial! For some it may be meditation or yoga, others may enjoy a hot bath, spending time with family or reading a good book. Anything that you find relaxing and enjoyable counts!

• Sleep: As with stress, poor sleep can rob our bodies of time to reset, repair and rejuvenate. If getting quality sleep is an issue during treatment be sure to work with your care team on a plan to improve sleep.

Pain Management

One of the most common causes of constipation during treatment is opiate pain relievers. This is an area where working with your care team can be most important. There are proven pain relief benefits to alternative treatments such as massage, acupuncture, and other healing modalities. Cannabinoid products have also been proven to help manage pain so a discussion with your team could be helpful to see if this is right for you. It may be beneficial to find a pain expert who can work with you to find ways of dealing with pain that can reduce your need to use opiate pain relievers, especially if constipation is an issue.

Constipation can be a direct side effect of treatment or other medications, it can also be a sign that your body isn’t functioning optimally. I hope these tips are helpful to you. It can be very beneficial to have a dietitian as part of your care team to help support your individual needs during this difficult time. I am here to support you, so please reach out with questions or to work with me and my team.