Constipation in Childhood Cancer

 

constipation

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Constipation occurs when a person cannot empty his or her bowels or has a feeling of needing to move the bowels but can’t. It starts when the body begins absorbing more water or begins signalling food to move through the bowel system more slowly. Constipation is a common symptom in people with cancer.

Abdominal surgery often affects the function of the GI tract and may result in either diarrhoea or constipation. Sometimes after abdominal surgery, scar tissue (adhesions) can result in a narrowing or partial blockage of the bowel; this may require surgery to reverse.

Cancer deposits may also grow in the abdomen, interfering with bowel function. The most serious form of this condition is a bowel obstruction, where the bowel becomes blocked by a tumour; surgery may be required to reverse this problem.

 

Symptoms

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

In addition to not being able to empty the bowels, people with constipation may experience the following symptoms:

  • Appetite loss
  • Confusion
  • Inability to urinate
  • Nausea and vomiting
  • Pain and cramping
  • Swelling in the abdomen

 

Causes

Several factors affect a person’s normal bowel function, including how much and what kind of food he or she is eating, the health of his or her gastrointestinal (GI) tract, and the medications the person is taking.

Common causes of constipation include not drinking enough water or other fluids, not eating enough fibre, and not exercising.

For people with cancer, however, the following cancer-related factors and cancer treatments might also cause constipation:

  • Being physically inactive
  • Bowel obstruction from scar tissue or tumours
  • Dehydration (not drinking enough water)
  • Diabetes
  • Eating less food
  • High levels of calcium in the blood
  • Low potassium levels
  • Medications, including antacids; some drugs to treat nausea and vomiting, seizures, depression, diarrhoea, or blood pressure; iron supplements; chemotherapy; and especially pain medications which can slow the muscular action of the bowel that helps food move through the system.
  • Thyroid problems
  • Tumour compression (cancer pressing on the spinal cord)

 

Diagnosis

The doctor may do a rectal examination or take an x-ray or other imaging scan of the abdomen to make sure your child does not have a tumour obstructing their rectum or at another point in the GI tract, as well as to find out whether there is hard stool in their rectum.

The doctor may also ask you about the following regarding your child:

  • Other diseases or illnesses
  • Use of medications that may cause constipation
  • What your child has been eating and drinking recently
  • Your child’s bowel habits, before the cancer and now

 

Treatment

It is critical to treat constipation properly. If it is left untreated, constipation can cause dehydration, internal damage to the intestine or rectum, or bowel obstruction. It can also slow the body’s absorption of medications taken by mouth. If scar tissue or a tumour is causing the problem, additional tests may be required. Talk with your health care team about the best way to manage your child’s constipation. Some of the following suggestions may help:

  • Ask your child’s health care team about treatment such as laxatives, an enema, or rectal suppository, as some of these may be harmful for some patients.
  • Ask your child’s health care team about changing the dose or stopping medications that cause constipation.
  • Give your child more liquids to drink, especially water
  • Give your child more fibre to eat or give them fibre supplements. If they have adhesions or tumour deposits that narrow your bowel, however, their doctor may recommend a low-fibre diet (low-residue diet) instead, because the fibre may back up behind the narrower areas of the bowel.
  • Increase your child’s physical activity if possible.

 

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