Constipation after chemotherapy and worried it will not clear- please help.

[Liz1tummypain]

I don't understand how my constipation will ever clear up. Maybe I'm being a bit dim, but I've not suffered from constipation much in my life so far. If it's relevant, I've finished 6 chemo cycles and waiting for a lumpectomy for breast cancer.

Apologies for the long description but I think it might be needed.

Not long after the last cycle I developed a fever, nausea and diarrhoea and was in hospital for a few days. This may or may not have had a role in the constipation I developed a few days later, but I don't know for sure.

In any case I didn't poop for several days and so I believed it was constipation and started to take movicol twice a day. At this point, I've sort of lost the plot. Chemo brain etc. We're now about 8 or 9 days on and the oncology 24 hr phone line people first said to start taking senna in addition to the movicol, then for one or 2 days I just took the movicol ( was having bad tummy pains at night). On Friday I was told to see my GP as the oncology people were so busy. My GP said to go back to taking both senna and movicol but to take the senna fairly early in the morning. The nights are really bad with sore tummy and cramps. Various people have felt my tummy.

So if it is impacted ( is that the word?) constipation, I don't follow how the real blockage will ever clear? In fact how do I know it really is there? My poops are sort of closer to liquid than solids but not as liquid as they once were- is that progress?

I'm finding it hard to believe it will ever sort itself out.

I remember having horrendous constipation while going through chemo, have you try a warm bath and manipulating your tummy? They also recommended sitting with your feet on a step? Also kiwis are good to help get things moving. You have my sympathies as it was awful.

How many movicol are you taking? Some people need up to 8 sachets per day to get fully cleared out. You could also try buying glycerin suppositories over the counter.

But if still in pain I would phone the chemo advice line again First.

@ranoutofquinoaandprosecco thank you.. Right I will send DH out for kiwis tomorrow and I think we've got a step I can use when on the loo. Many thanks. Can I ask if yours was said to be impacted? And if so did you just have to wait until something solid passed?

ive not been through chemo but have chronic health conditions which my medication gives me constipation. What works for me is using movicol to soften the stool but then you need something to move it along. Prune juice is by far the best thing that works for me. A large glass usually cold from the fridge.

sit with you legs up on something when your on the toilet. Lean slightly forward and breath slowly out through your lips in an “o” shape and rock back and forth.

hope this helps!

I'm taking 2 a day but yes, I think the GP said I could try taking more. It's just I've discovered both senna and movicol lead to spasms, ( altho' senna is the worst of the two for this). Maybe I should try and be brave and go up to 3 a day. Ok thanks. I don't understand how they know I really do still have constipation or whether it's the meds that are now causing the problem. Hope you understand.

Oh you poor thing. I had chemo for BC and my stomach was absolutely shot through chemo. One minute constipated and the next diarrhoea. It will pass but it’s horrid. I was told it was the chemo meds that caused it - not surprising really! Drink as much as you can and then some more, tummy massage will definitely help get things moving too - try it yourself or if you have a partner who could help? I also had lactulose most days to keep things soft which also helped me.
Don't be afraid to keep contacting your oncologist helpline or GP. I hope it sorts itself out soon 💐

@Liz1tummypainI remember wondering if it was impacted but it wasn’t just really backed up. I think indefinitely upped the Movicol and drank so much water, prune juice etc. Have you tried a coffee, caffeine sometimes works as well.
I’d also be on the phone to your chemo team tomorrow if no change as it’s one of the things that’s really common but no one talks
about! The same as the loss of eyelashes and nose hair which means you always look as if your crying and you have snot dripping.
It definitely does get better though.

If anyone remembers taking senna and movicol, can you say how many movicols you took each day please?

I was impacted due to the strong drugs and the fact that chemo slows your digestive system right down. Normally I take loperamide permanently but I ended up in a&e twice requiring an enema each time. It cleared it. Has nobody suggested an enema to you?

No, nobody has suggested an enema.. although actually I did raise it when I saw the GP and I think his response was an enema wouldn't reach the part it needed to - does that sound reasonable?.

I found Glycerol suppositories helpful.

A second vote for prune juice or a tin of prunes. Hot water bottle on the tummy and warm bath may also help.

I have worked in oncology and have family experience of chronic constipation, I feel for you OP, it's really brutal.

Senna is a stimulant, that is, it makes your bowel contract, which is what pushes the stool through your system, and is why it gives you tummy cramps. Specifically, senna on an impaction/hard stool is going to be extra painful, and I wonder if this is what's happening with you.

If there's an impaction, 2 sachets of movicol isn't going to touch the issue, I've just checked the adult dosing and it would start at 4 sachets, increasing by 2 each day until you get to 8, which should be taken in a 6 hour window. Please note I'm not suggesting you do this, it's just for background on how impactions are treated. I would suggest you speak to your GP (I know you said they mentioned you could increase the movicol) and ask them specifically if they think you should follow a 'disimpaction regime ' - unfortunately GPs aren't always as on top of it with constipation as they should be and you sometimes have to be a bit more proactive sadly.

You want to give the movicol a good few days at a higher dosage to do it's thing before reintroducing senna, as the movicol is a different type of laxative, that works by binding to water so that your body doesn't absorb it and the water stays in your bowel. When you're constipated, the bowel has longer to absorb more water out of the stool (because it's in the bowel for longer) meaning the stool gets harder and drier and then eventually gets stuck because it's harder to move. The more that builds up, the harder it gets to mlve. You want the water bound to the movicol to basically soak into the impaction and soften it back up, so that the senna can help your bowel move it along and out.

Make sure you're drinking loads of water (in addition to the water mixed with the movicol), water fruit/prunes/fruit juices are also all excellent help. Soluble fibres are great, as they create a gel consistency which helps moisten things up, but go easy on insoluble fibres as they will just add more bulk to an impaction if it's there.

Keep your oncology team updated too. I know they were too busy to see you on Friday, but they will know you best and know what your individual risks/protocols are (we for example used to avoid enemas/suppositories for chemo patients as the mucus membranes are so delicate, but they may feel differently, or decide there's a point where untreated constipation is more of a risk to you. There's also different softeners and stimulants that can be prescribed instead/as well if needed if things don't look like they are improving.

Wishing you all the best, OP!

Maybe your impaction is higher up and an enema wouldn't work. I feel for you as it's such a miserable and painful condition. Maybe if increasing the movicol doesn't work, you could try requesting an enema again. I really hope the issue resolves for you soon.

@Liz1tummypainmy constipated son takes both, having upped from just Movicol. Movicol makes it soft; sennikot makes you feel the urge which might feel like spasms. The GP explained it like Senna "irritates." This is important for kids who ignore their bodies because you only feel the stretch eg the urge to go when the bowel fills and if you ignore, you don't feel again until it fills more. Sennakot and other senna products essentially make it so they can't ignore it because it will get it moving.

I agree with others who said you probably need more Movicol and to assume at this point an impaction. I'd give two sachets to a small child and your intestinal track is much larger.

My mom recently had cancer and was given bottles of Ensure to drink. I had also sent her the prune sachets from the baby section at Sainsburys (she hates prunes) but she never needed them because Ensure seemed to get things moving.

Also stay very hydrated. The water mixed with the Movicol doesn't count.

keep up your water intake. That can be difficult with the stomach pain and the chemo, but it is necessary for the movicol to work. If you need to switch to something more tantalizing to get the liquid down, do that.

Once you get things back to normal, you will probably discover a routine of when you need to take laxatives to prevent a recurrence.

I'm currently having chemo and have always suffered from constipation so it's even worse now. I've had good success by drinking warm water with lemon first thing in the morning, and drinking a lot more water, 8-9 glasses a day. I'm trying to add fibre to every meal as well. I have found that a short, fast walk really helps too.

I feel your pain (literally)
only had one round of chemo but my digestive system has packed up already.
i got through an entire bottle of laxative meds last week. 4x the dose on the bottle, on the advice of my oncology nurse.
I think you may need to up your dose, but speak to them first if you can

I would call your oncology advice line and speak to one of their team. Explain exactly what you have done so far and they can hopefully advise what the best course of action is or bring you in to check for impaction. Hope things improve for you very soon!

Thanks to everyone who is replying. The tummy pain was so bad that I did call the oncology people..now waiting in A&E. Done bloods
I expect thry will see I'm a bit dehydrated..I just want to understand how they think it will clear.perha pop s I'll get sent home and told to increase the movicol but I am going to feel better if they give me some new advice.
Thanks again :)