Constipation is common in people with an advanced chronic disease. Constipation is when it’s hard to have bowel movements [poop/stools]. Your bowel movements may be hard and dry, difficult or painful to pass, and happen less than 3 times a week.

  • Constipation can be different for everyone.
  • The normal length of time between bowel movements can vary from person to person. 
  • Going longer than 3 or more days without a bowel movement is usually too long.
  • Having a bowel movement every 1 to 2 days is a good goal. 
  • Constipation can become a serious problem. It can lead to a bowel obstruction, where stool has blocked a portion of your bowel. 

If you are experiencing constipation along with: nausea, vomiting, a swollen abdomen and/or abdominal cramping or pain, speak to your health healthcare provider as soon as you can.

Constipation can be caused by not moving around much or ignoring the urge to empty your bowels. Other causes can be:

  • Medications: Pain medications, called “opioids” (such as morphine, hydromorphone, oxycodone and Tylenol 3) may cause constipation. Opioids slow down the movement of poop/stool through your bowel [intestines]. This gives your bowel more time to take the water out of your stool, making it  hard, dry and difficult to pass.
  • Treatments: Cancer treatments such as chemotherapy can also cause constipation
  • Other symptoms/conditions: Like stress and anxiety.
  • Nutritional problems: Not eating enough fibre in your diet.
  • Not drinking enough fluids: Anything that is a liquid at room temperature is a fluid e.g., water, coffee/tea, pop, milk, soup or alcohol.

Managing constipation works best when you play an active role. 

  • Try to figure out if there is a cause for your constipation. 
  • Is it better or worse at different times?
  • What helps or makes it worse? 

You may want to use a symptom diary to record information about your constipation. Tracking this information will help you talk to healthcare team about your constipation.

Physical Steps you can try

  • Medication: If you take medication for your constipation take it as prescribed so your symptom doesn’t get too bad.
  • Gentle exercise: If it’s safe for you get active. Increasing your physical activity will help to get your bowels moving. Activities like walking, stretching or riding a stationary bike will help your bowls move.  Every movement helps.
  • Drink plenty of water: Drink as much fluid as your doctor or dietitian have told you to drink.
  • Eat a healthy diet: Try and eat often and throughout the day. Small snacks throughout the day can help with low appetite. The act of eating can stimulate the bowel.
  • Train your bowels: Use the bathroom when you wake up and after you eat meals.
  • Go to the bathroom as soon as you feel the urge: Do not ignore the urge to have a bowel movement.
  • Sit straight: When using the toilet and if needed, try using a raised toilet seat, foot stool or bedside commode to help you do this.
  • Increase your fibre intake: Only if it’s safe for you.

Adding more fibre to your diet:
Speak to your healthcare team about the right food choices for you and how much fibre you should be eating before increasing the amount of fibre in your diet. Some people with certain types of chronic disease for example kidney, liver or heart disease may need to be careful when adding fibre to their diets. Some foods high in fibre such as bran, beans, lentils, nuts and seeds are also high in phosphorus and potassium and may need to be limited. 

  • Increase slowly: Increase your fibre intake slowly. 
  • Spread your intake: Do not have your fibre intake all in one meal; spread your intake of fibre throughout the day.
  • Fruits with the most fibre: Pears, apples, raspberries, blueberries, peaches, strawberries, cherries and grapes. 
  • Vegetables with the most fibre: Green peas, turnips, corn, carrots (boiled), cabbage, green or yellow beans, lentils, broccoli (raw) and cauliflower.
  • Prunes: Try adding a small number of prunes to your diet. You should have no more than 3 dried or canned prunes per day and no more than ¼ cup (60mL) of prune juice per day.

Speak with your healthcare team if constipation is a problem for you. Your worries and questions are important to you and them. Your healthcare team may speak to you about the different medications you can take.

  • Let them know if you think you’re your medical condition or medications are the reason you are constipated.
  • Let your healthcare team know if a medication is working for you or if you’re having side effects. You may have to try a few different ones to know what works best for you.
  • Talk to them before taking over-the-counter medication, including vitamins and herbal remedies.

 Tips on sharing your symptoms with your healthcare team:

  • Make some notes about your constipation symptoms and tell your healthcare team about them.
  • Has there been a change in your constipation?
  • How bad is it?
  • When does it happen and how long does it last?
  • What makes it better or worse? What have you tried already?
  • Make a list of all the medications you are taking including over the counter medications.