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nutrition / diet

Question

Hello I am on my 2nd cycle out of 6 of chemo. (FEC)They give me domperidone for the sickness, emend for the 1st two days after chemo and omeprazole for acid. However I suffer badly from constipation. It may be 4-5 days before I go and this is with the aid of either califig or senna. My stomach becomes so distended, and i feel sick all through the day. I drink fresh juices each day and eat lots of veg and fruit, water, home made soups etc Any suggestions ?

Answer

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 you are eating less than usual, or perhaps taking less exercise then this can make constipation more likely too.

Speak to your doctor/ health care professional about the symptoms you're experiencing. They will have a full knowledge of your medical treatment and be able to make recommendations to help improve your symptom control. Advice will be tailored depending on the site of your cancer. For example, a cancer in the abdomen may need to be treated with a low fibre diet rather than high fibre because of the possible risk of bowel obstruction.

Laxatives are often required to promote a regular bowel motion when you are undergoing cancer treatment, and the doctor will advise whether this would be beneficial in your case.

General advice to help ease constipation is as follows:

1. Increase the amount of fibre in the diet. Check with your medical team that this is advisable for you 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, fruit juice, milk and milky drinks.
  • 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, fruit juice and milk instead.

3. If you are able to take any exercise, this will also encourage a regular bowel movement.

If your doctor advises you to follow a low fibre (sometimes referred to as low residue) diet I would recommend that you ask to be referred to a registered dietitian for individual advice. This can be arranged by your GP or hospital clinician.