Ask the expert

constipation

Question

My husband has cancer in the tail of the pancreas and liver mets, he has been constipated for around 3months now, he currently started chemo last week and is taking movicol to help but doesn't seem to help much at all, he is now feeling very sick and not eating well he also finds it very hard to swallow. He is also a diabetic can you help?

Answer

It sounds like there are a number of things affecting your husband's nutritional intake at present. I think that he would benefit from seeing a Registered Dietitian who will be able to undertake an individual nutritional assessment, taking into account your husbands specific eating and drinking difficulties in order to provide you with personalised specialist dietary advice.  If your husband would like to see a Registered Dietitian, he can ask his GP or Hospital Doctor to make a referral.Constipation is a common problem experienced by people with cancer and during cancer treatment. Constipation has several possible causes. Some chemotherapy drugs are known to result in constipation, as are medications such as painkillers and anti-sickness drugs. If your husband is feeling sick, it's understandable that he doesn't feel like eating and drinking as much as usual. This could result in an inadequate intake of both dietary fibre and fluid, both of which are important to keep our bowels working regularly. If he is less active than usual, this will slow down the movement of stools through the gut and make them harder to pass.I would advise you to speak to your Husbands medical team for further advice on his constipation. They will be able to review his current medications and identify factors that may be contributing to his constipation. They may recommend changing the dose of Movicol, changing to another drug or perhaps introducing an additional laxative as different drugs have different roles (e.g. softeners, bulking agents, osmotic laxatives).The following general dietary advice may help to reduce constipation;

1.Increase the amount of fibre in the diet. Check with your husband's medical team that this is advisable in his particular case before introducing any dietary changes. Examples of high fibre foods include:

  • Wholegrain pasta or rice instead of white rice
  • Wholemeal or granary bread instead of white bread
  • High fibre breakfast cereals e.g. Branflakes, Shredded Wheat, porridge oats, Weetabix
  • Dried fruit, nuts, seeds
  • Fruit and vegetables - raw or cooked. Try leaving the skin on where possible
  • Biscuits or cakes made with wholemeal flour instead of white flour
  • Pulses, beans and lentils. Try adding them to soups, stews and casseroles

 

2.Drink plenty of fluid.

  • Drinking plenty of fluid will help to soften stools and make them easier to pass.
  • Try to aim for 8 - 10 glasses of fluid each day e.g. water, squash, milk and milky drinks. Fruit juice is high in fruit sugar, so it can cause blood sugar levels to rise quickly. For this reason, it's often advised that people with diabetes drink juice with a meal and avoid having too much in one day. The Dietitian will be able to give you specific advice in your husband's case.
  • Drinking large amounts of drinks that contain caffeine, e.g. coffee and cola can lead to dehydration and ultimately make constipation worse. Try to cut down on these drinks and increase water, squash and milk instead.

 

If your husband is able to take any exercise, this will also encourage a regular bowel movement.People with diabetes are generally encouraged to take a diet low in fat, sugar and salt. When people have cancer and are undergoing cancer treatment, the recommendations often change to a diet higher in protein and calories. This is important to help prevent weight loss and nutritional deficiency. It is not possible to offer general advice and again, I would recommend that your Husband sees a Registered Dietitian for tailored advice.