Chemo and constipation. Oh, poop! As a pelvic floor physical therapist and breast cancer thriver who is currently in the home stretch of chemotherapy, I can personally testify that constipation is no joke!
Having regular bowel movements during chemo is important to help detox the body of chemotherapy medications. In doing so, other side effects of chemo can be reduced. Backed-up bowels can contribute to or worsen nausea and vomiting. Unmanaged constipation during chemo can cause painful hemorrhoids or anal fissures that can put a patient at risk of infection while immunocompromised.
So how do we treat or avoid constipation during chemo? Well, let’s start with the basics and go from there…
What is constipation?
Typically, a person should expect to have a bowel movement anywhere from three times per day to three times per week. Stools should be soft and easy to pass (like #3 or 4 on the Bristol Stool Chart below). You may have constipation if your bowel movements are irregular (several days pass between BM’s) or your stool is very firm and is painful or requires straining to pass. Sometimes, it may feel that you’re not able to empty your bowels completely as well.
What causes constipation?
Generally, constipation is related to not getting enough water or fiber in your diet. It can also be from not getting enough exercise or from changing your routine when you travel. Unfortunately for some people going through cancer treatment, certain chemotherapy medications can cause gastroparesis (slow or paused digestion of food), which can lead to constipation.
How can you relieve constipation?
*Drink warm liquids (water, tea, coffee) first thing in the morning to kick start digestion and bowel movements, and be sure to drink plenty of water throughout the day (aim to drink half your body weight in ounces of water).
*Exercise! Take a short 10-15 minute walk or try these gentle stretches to stimulate the bowels.
Supine Twist Stretch 
Happy Baby Pose 
Seated Twist Stretch
*Eat plenty of fiber. Try to eat 25-30 grams of fiber daily with foods like broccoli, Brussels sprouts, beans, lentils, oatmeal or whole grains.
*Practice good toileting habits:
- Use proper pooping posture – place your feet on a stool or rest your elbows on your knees to make it easier to empty the rectum.
- Relax your pelvic floor muscles & breathe!
- Don’t strain – come back later if you’ve got to push!
*Try supplements and medications if the above fail. Ask your doctor about magnesium supplements, fiber/psyllium supplements (like Benefiber or Metamucil), stool softeners, or laxatives that might be helpful.
Remember: When it comes to constipation – consistency is key! Don’t scale back on your bowel routine because things begin to lighten up. During chemotherapy, you’ve got to stay on top of things to stay comfortable. If you need help getting a routine that works well for you, ask your doctor about a referral to a pelvic floor physical therapist in your area!
*This blog is part 1 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.
Aloha ❤
Bri D. PT. 