Constipation From Treatment and How to Get Relief
Many people think of nausea or diarrhea as the most common gastrointestinal side effects of chemo and other treatments, but constipation is right up there with them. Constipation means you're pooping less frequently than normal, and poop may be difficult to pass.
Many breast cancer treatments cause constipation, but during treatment, your eating habits may change, you may not drink enough liquids, and/or you may be less physically active. These changes can also cause constipation. Many people also get constipated after taking medication to manage diarrhea.
Constipation is usually not serious, but it might make you feel bloated, crampy, sluggish, and less hungry than usual.
Eating — or avoiding — certain foods, staying hydrated, moving your body, and taking laxatives can help.
What treatments cause constipation?
Breast cancer treatments that commonly cause constipation include
chemotherapy medications like vincristine (brand names: Oncovin, Vincasar PES, Vincrex) and Halaven (chemical name: eribulin)
hormonal therapies like tamoxifen (brand names: Nolvadex, Soltamox) and anastrozole (brand name: Arimidex)
targeted therapies like Enhertu (chemical name: fam-trastuzumab-deruxtecan-nxki) and Kadcyla (chemical name: T-DM1 or ado-trastuzumab emtansine)
immunotherapies like Keytruda (chemical name: pembrolizumab) and Tecentriq (chemical name: atezolizumab)
Pain medications — including morphine, codeine, and other opiates — and supportive medications like Zofran, an anti-nausea medication, can also cause constipation.
What to eat and drink when you’re constipated
Drinking plenty of water and adding certain foods to your diet, like high-fiber fruits, vegetables, and other plant foods, can help get things moving.
Staying hydrated
Experts recommend that all adults drink 6 to 8 glasses of water a day. This is especially important when you’re dealing with constipation, as water keeps the digestive tract lubricated and helps the muscles of the intestines contract normally.
Foods with fiber
When deciding what foods to incorporate when you’re constipated, focus on fiber. Foods high in fiber include:
legumes like black beans, chickpeas, and lentils
whole grains like oats and oat bran, barley, rye, and quinoa
veggies like spinach, kale, Brussels sprouts, potatoes, and broccoli
fruits like plums, kiwis, avocados, oranges, pears, raspberries, figs, and apples
seeds like chia and flax
nuts like almonds and walnuts
Oncology dietitian picks
Sorbitol is a natural sugar alcohol found in some fruits that can have a laxative effect. It’s often added to gum, candy, and other foods.
In addition to being high in fiber, prunes contain the highest amount of natural sorbitol, which helps bring water to the intestines to make stool move — if you’re well hydrated. So when you reach for dried plums, grab a glass of water, too.
Kiwis aren’t just a high-fiber, high water content food. They also contain a natural enzyme called actinidin that may support digestion and healthy bowel movements. Some oncology dietitians recommend eating two kiwis each day if you’re constipated.
Consider trying foods with live and active probiotics. These microorganisms support your gut microbiome and help move poop through the digestive tract. Food and drinks rich in probiotics include yogurt, sauerkraut, kimchi, tempeh, kefir, and kombucha.
Warm beverages, like coffee, tea, broth, or warm lemon water, can trigger colon contractions and help relax your intestinal muscles to make passing stool easier.
Foods to avoid when you’re constipated
Different foods affect people differently, but there are a few general guidelines when it comes to eating when you’re constipated.
Foods high in fat and low in fiber, like cheese, red meat, and eggs, can slow down digestion and worsen constipation.
These foods — along with ultra-processed, high-sodium foods like french fries, pastries, packaged snacks, and frozen meals — can also pull water out of your intestines, making stool drier and harder to pass.
Try to avoid alcohol, too — it dehydrates your body and slows down the muscles in your digestive tract.
Experts don’t recommend drinking extra caffeine. Although some caffeine can stimulate digestion, too much can dehydrate you.
Both alcohol and caffeine are diuretics, meaning they make you urinate more. The more water and fluids that your body is loses, the harder it is to keep digestion running smoothly. Both alcohol and caffeine can also irritate the digestive tract, leading to discomfort and potentially worsening constipation.
Moving your body to get your bowels moving
While you’re in treatment, you may not have the energy or ability to exercise much. But physical activity can help stimulate your digestive system.
Even short walks or gentle workouts can help. Try going for a walk 10 or 15 minutes after finishing a meal to get things moving. Walking after eating can also reduce bloating and gas.
Exercise can also ease other treatment side effects like fatigue, depression, insomnia, and more.
Laxatives and other medications
If you’ve been staying hydrated, adding fiber, and exercising but you still feel backed up, there are over-the-counter (OTC) and prescription medications that can help:
osmotic laxatives like milk of magnesia and MiraLAX
stimulant laxatives like Dulcolax and Ex-Lax
stool softeners like Colace (docusate sodium)
lubricants like mineral oil
Natural laxatives can also help:
senna
psyllium husk
magnesium citrate
All laxatives — prescription, OTC, and natural — can cause side effects, including bloating, nausea, vomiting, and diarrhea. Long-term use is not recommended. Always talk to your doctor before trying any new medications or supplements, even if they’re available over the counter.
Constipation — Breast Cancer Treatment Side Effects
With guest William Chey, MD
Apr 12, 2019Side Effects
This content is made possible, in part, by AstraZeneca.