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Constipation in Cancer

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Constipation in Cancer, Constipation in Terminally Ill Patients, Cancer Related Constipation, Palliative Management of Constipation

  • See Also
  1. Bowel Regimen in Chronic Narcotic Use
  • Causes
  1. Attempt to identify cause
  2. Do not assume Narcotics are always the cause
  • Differential Diagnosis
  1. Bowel Obstruction in Terminally Ill Patient
  • Management
  • Address each of four factors
  1. See Bowel Regimen in Chronic Narcotic Use
  2. Low intestinal solids
    1. Due to decreased Dietary Fiber
    2. Manage with Psyllium
      1. Avoid in Dehydration due to stool impaction risk
  3. Low stool water content
    1. Causes
      1. Dehydration
      2. Slow stool transit time
      3. Decreased intestinal water secretion
    2. Management
      1. Lactulose 30 ml PO every 8 hours until stool
      2. Sorbitol 30 ml PO q2-4 hours until stool
      3. Polyethylene Glycol (Miralax) 1 tablespoon (17 g) in 8 oz fluid orally daily
      4. Magnesium Hydroxide 30 to 60 ml orally at bedtime
      5. Glycerin suppositories
  4. Low gastrointestinal motility
    1. Causes
      1. Non-ambulatory or bed-ridden patient
      2. Neurodegenerative disease
      3. Medications
        1. Morphine and other Opioids
        2. Tricyclic Antidepressants
        3. Scopolamine
        4. Diphenhydramine (Benadryl)
        5. Vincristine
        6. Calcium Channel Blockers
        7. Iron Supplementation
        8. Calcium Supplementation
        9. Aluminum salts
    2. Management
      1. See Opioid Induced Constipation for Bowel Regimen in Chronic Narcotic Use
      2. Senna with Docusate 1 to 2 tabs orally 2 to 4 times daily
      3. Bisacodyl
      4. Prune juice
      5. Casanthranol
  5. Decreased gastrointestinal lubrication
    1. Due to Dehydration
    2. Management
      1. Mineral Oil Enemas
      2. Glycerin suppositories
      3. Dioctyl Sodium sulfosuccinate
  • Management
  • Non-Cancer Comorbid Condition Palliative Measures and Precautions
  1. Cardiac disease (e.g. CHF, CAD, Transplant Rejection)
    1. AVOID high salt Laxatives (Magnesium Citrate, Magnesium Hydroxide, Sodium phosphate) if on signficant Diuretics
    2. AVOID Stimulant Laxatives (Senna, Bisacodyl)
    3. Prefer Osmotic Laxatives, such as Polyethylene Glycol (Miralax) or Lactulose
  2. Renal disease (e.g. Chronic Kidney Disease stage 4-5, Acute Renal Failure)
    1. AVOID high salt Laxatives (Magnesium Citrate, Magnesium Hydroxide, Sodium phosphate)
    2. Osmotic Laxatives, such as Polyethylene Glycol (Miralax), are safe, but require good hydration for efficacy
    3. Consider Stimulant Laxatives (Senna, Bisacodyl)
  3. Liver disease (e.g. end-stage Cirrhosis)
    1. Osmotic Laxatives (esp. Lactulose) for Hepatic Encephalopathy or Ascites
    2. Stimulant Laxatives (e.g. senna)
  4. Neurologic disease (e.g. ALS, Dementia, Parkinsonism, stroke)
    1. Scheduled toileting
    2. Osmotic Laxatives (Polyethylene Glycol)
    3. Stimulant Laxatives (e.g. senna)
  • Prevention
  1. See Bowel Regimen in Chronic Narcotic Use
  2. Prevention is much easier than treatment
  3. Administer prophylactic medications with Narcotics
    1. Gastrointestinal motility Stimulant Laxative and
    2. Stool Softener
  4. Example Agent: Pericolace
  • References
  1. Albert (2017) Am Fam Physician 95(6): 356-61 [PubMed]
  2. McGregor (2025) Am Fam Physician 112(5): 493-503 [PubMed]
  3. Ross (2001) Am Fam Physician 64(6):1019-26 [PubMed]