Address Constipation during Chemotherapy by Brianna DeWitt, PT, DPT
Chemo and constipation. Oh, poop! As a pelvic floor physical therapist and triple negative breast cancer thriver who is currently in the home stretch of chemotherapy, I can personally testify that constipation is no joke!
Having regular bowel movements during chemo is important to help detox the body of chemotherapy medications. In doing so, other side effects of chemo can be reduced. Backed-up bowels can also contribute to or worsen nausea and vomiting. Unmanaged constipation during chemo can also cause painful hemorrhoids or anal fissures that can put a patient at risk of infection while immunocompromised.
So how do we treat or avoid constipation during chemo? Well, let's start with the basics and go from there...
What is constipation?
Typically, a person should expect to have a bowel movement anywhere from three times per day to three times per week. Stools should be soft and easy to pass (like #3 or 4 on the Bristol Stool Chart below). You may have constipation if your bowel movements are irregular (i.e. several days pass between BM's) or if your stool is very firm and is painful or requires straining to pass. Sometimes, it may feel that you're not able to empty your bowels completely as well.
What causes constipation?
Generally, constipation is related to not getting enough water or fiber in your diet. It can also be from not getting enough exercise or from changing your routine when you travel. Unfortunately for some people going through cancer treatment, certain chemotherapy medications can cause gastroparesis (slow or paused digestion of food), which can lead to constipation.
How can you relieve constipation?
● Drink warm liquids (water, tea, coffee) first thing in the morning to kick start digestion and bowel movements, and be sure to drink plenty of water throughout the day (aim to drink half your body weight in ounces of water).
● Exercise! Take a short 10-15 minute walk or try these gentle stretches to stimulate the bowels.
● Eat plenty of fiber. Try to eat 25-30 grams of fiber daily with foods like broccoli, Brussels sprouts, beans, lentils, oatmeal or whole grains.
● Practice good toileting habits:
○ Use proper pooping posture - place your feet on a stool or rest your elbows on your knees to make it easier to empty the rectum.
○ Relax your pelvic floor muscles & breathe!
○ Don't strain - come back later if you've got to push!
● Try supplements and medications if the above fail. Ask your doctor about magnesium supplements, fiber/psyllium supplements (like Benefiber or Metamucil), stool softeners, or laxatives that might be helpful.
Remember, when it comes to constipation – consistency is key!
Don't scale back on your bowel routine because things begin to lighten up. During chemotherapy, you've got to stay on top of things to stay comfortable. If you need help getting a routine that works well for you, ask your doctor about a referral to a pelvic floor physical therapist in your area!
Sources:
ABC News. 2020. The Bristol Stool Chart. [online] Available at: <https://www.abc.net.au/news/2015-11-10/the-bristol-stool-chart---full-image/6927778?nw=0> [Accessed 2 October 2020].
MedBridge. 2020. Online Ceus For PT, OT, SLP, AT | Continuing Education | Medbridge. [online] Available at: <https://www.medbridgeeducation.com/> [Accessed 2 October 2020].
Macmillan.org.uk. 2020. Managing Bowel Problems After Pelvic Radiotherapy - Macmillan Cancer Support. [online] Available at: <https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/radiotherapy/pelvic-radiotherapy/managing-bowel-problems-after-pelvic-radiotherapy> [Accessed 2 October 2020].
Brianna DeWitt, PT, DPT is an orthopedic physical therapist specializing in pelvic floor, oncology, and vestibular rehabilitation in Honolulu, Hawaii. She holds a B.S. in Health and Human Performance/Exercise Science from the University of Montana and received her Doctorate in Physical Therapy from Eastern Washington University. Brianna is passionate about prevention and wellness and is currently in pursuit of a certification teaching the Pilates mat work.
In her spare time, she enjoys Pilates and spin classes, shopping at local farmer’s markets, and spending time outdoors with her husband.
In April 2020, Brianna was diagnosed with early-stage triple negative breast cancer at the age of 30. Currently in active treatment, she’s been compelled to share her story with others so that they may be comforted and prepared to take on a new cancer diagnosis.
Follow her journey and find other PT and cancer-related tips on my blog www.bridpt.blog or on Instagram @bri.d.pt!