Are you stopped up? Regular bowel movements can vary from two to three per day or from only going two to three times per week. If you’re not going as often as you normally do during cancer treatments you are not alone. Many people struggle with constipation, but you might be at higher risk depending on your tumor location, cancer treatments, medications, if there is not enough fiber in your diet, if you don’t drink enough fluids, or if you’ve been inactive for a long period of time. If your oncologist suggests you are at risk based on your anti-cancer agents there are things you can do to prepare.
Focus on Fiber
Managing your constipation might include increasing your fiber intake up to 35 grams per day, but you will want to do so gradually. Your your body needs time to adjust when increasing fiber to prevent gas and bloating. You can try adding a new fiber food each day to evaluate for tolerance and eventually try eating a fiber rich food with each meal and snack. Foods rich in fiber include beans, bran, fruits, veggies, nuts, seeds, and whole grains. Whole grains include brown rice, wild rice, barley, oats, quinoa, faro, kamut, high fiber cereals, whole wheat or sprouted breads, or lentils. Stick with fresh, frozen, or dried produce items instead of juice as juice is usually devoid of fiber. You can add chopped or dried fruit to cereals, salads, and cooked grains for more fiber. Additionally lentil soup, bean burritos, bean dip or hummus may be helpful for increasing fiber.
The only way to really know if you are getting a good source of fiber is to take a look at the food label and see how many grams of fiber there are per serving. On average 3 grams of fiber or more per serving is a good choice and anything less is considered low in fiber. Compare a few labels and try a brand that offers more fiber. Of note, some people may not be able to follow a high fiber diet depending on their medical conditions—you always want to check with your oncologist first.
If you start adding fiber to your diet, you want to ensure you are staying well hydrated as dehydration can make your constipation worse. Drink when you are thirsty and aim for about half an ounce of fluid per pound of body weight. A good indicator of adequate hydration is if your urine is clear or light yellow. As with increasing fiber, you want to check with your oncologist to make sure increase fluid is okay for you. Some people may need to have fluid restrictions and increasing fluid may not be appropriate.
Physical activity can stimulate bowel function. Aim for 30 minutes three times per week if okay with your doctor. Even a 5 minute walk can make a big difference.
Are you taking an Iron Supplement?
If you are, iron supplements may make your constipation worse. Check with your medical provider to see if you might be able to take smaller amounts several times per day. Your iron supplement may be important for you to continue taking in it’s original prescribed amount. If that’s the case you can try other nutrition strategies to aid in reducing slow moving bowels.
Warm prune juice, warm tea, or coffee may help to stimulate the bowels. Some of my patients have reported that Senna tea can help as well. Try drinking warmed beverages after eating for increased effectiveness.
Set up a regular regimen
Don’t ignore the urge to use the bathroom if you are able to. You can even try to eat and exercise at the same times each day. Some people have found it helpful to try to use the restroom at the same time daily even.
If nothing seems to be working, talk to your medical care team
You may benefit from the addition of a laxative or your pain medication type and dosage might be able to adjusted to better suit your bowel regularity. Some over the counter stool softeners may be helpful, but always let your medical care team know about any adjustments you make so that you can have the best plan tailored for you. Contact your team if it’s been longer than 3 days without a bowel movement.
Going through cancer treatments can cause unwanted side effects, but often can be managed thought a combination of methods. Talk to your medical care team and ask for a consult to see a registered dietitian as most hospitals have one on staff who may be able to personally help you. Don’t be afraid to speak up and keep your oncologist updated so your quality of life can be improved.
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