Constipation is one of the most bedeviling complications of cancer treatment. When you are finally able to eat again, then your digestive tract decides it won't let go of food. You either can't go at all, or stools become hard, pellet-like, and nearly impossible to pass. Either way, constipation is uncomfortable. It causes fullness, a sense of not quite having finished defecation, and straining.
There are many ways cancer treatment can lead to constipation. Surgery and radiation can damage muscles lining the digestive tract. Inactivity can also lead to constipation.
When chemotherapy or radiation cause mouth sores, fiber-rich vegetables and fruits are hard to eat. Opioid painkillers such as buprenorphine, codeine, destropropxyphene, fentanyl, morphine, pethidine, or tramadol, paralyze the muscles that enable peristalsis, the passage of food through the digestive tract. Medications to stop diarrhea and vomiting often have the same effect.
If you have been unable to eat very much and you've taken care to get your protein from, say, something easy like a cheeseburger, you've contributed to constipation. There are chemical compounds in beef, wheat, and dairy foods that lock onto the same cell receptor sites as the opioids in painkillers. These food opioids also cause constipation.
Constipation complicates recovery from cancer
Studies of laboratory animals find that accumulation of stool in the colon allows pathogenic organisms to multiply in colonies, rather than singly. A constipated colon fails to flush Salmonella and similar organisms away with the passage of stool.
In women over age 40, constipation increases risk of urinary incontinence. Calcium prevents the absorption of calcium from food and supplements in women at risk for osteoporosis. Constipation accelerates wasting in because it interferes with absorption of nutrients.
Recovery from hormone-stimulated cancers is especially slower when there is constipation
Slow movement through the bowel gives disease-causing bacteria a chance to reassemble the recycled testosterone and estrogen broken down by the liver and excreted with bile. These reassembled hormones find their way back into general circulation. They can stimulate abnormal growth in breast tissue in women and in prostate tissue in men. One research study found that untreated chronic constipation is also an important risk factor in colon cancer, especially among middle-aged people who take laxatives.
Laxatives are not the answer for constipationUsing certain kinds of laxatives, paradoxically, can even cause constipation. Saline laxatives, such as milk of magnesia, draw fluids into the lumen (the cavity) of the intestine to loosen stool. They can draw so much fluid into the intestine that, after being initially effective, they cause constipation. If you use milk of magnesia, Epsom salts, mineral oil, mineral water, or any other saline laxative, you need to drink at least 10 cups (2500 ml, or 5 glasses) of water a day. This will prevent dehydration.
Laxatives are especially detrimental for the elderly. Using laxatives depletes the body’s supply of folic acid. This increases levels of homocysteine. People over age 80 whose mental faculties are still sharp tend to have lower levels of homocysteine. People over age 80 who have age-related memory problems or Alzheimer’s tend to have higher levels of homocysteine.
If laxatives aren’t the answer, what is?The first thing that comes to mind for most people seeking to remedy constipation is bran. Bran makes larger stools that move through the gut more quickly, but there are complications in using bran effectively. Bran accelerates the passage of other kinds of food through the colon, but slows down the passage of food through the stomach. The longer food stays in the stomach, the greater the likelihood of acid reflux, belching, burping, or heartburn.
Coarse bran is more useful in relieving constipation than fine bran, but it is also more likely to cause heartburn. Once bran reaches the colon, it is the last food eliminated. If you eat bran for breakfast and skip lunch, the bran you eat will probably be eliminated in your next bowel movement. If you eat bran for breakfast and then eat an early lunch, bran does not get a chance to leave the colon and can cause swelling, bloating, and gas.
Another popular food for relieving constipation is prunes It is difficult to imagine how hundreds of millions people around the world who eat prunes to encourage regularity could be wrong, but there is not a single scientific study validating their use in treating constipation. Scientists speculate that prunes stimulate bowel movements through a mechanism similar to milk of magnesia: their high content of the sugar sorbitol draws fluid into the colon and makes the stool softer and more watery.
Prunes have another scientifically demonstrated nutritional value: They are a rich source of potassium, which is beneficial to cardiovascular health, and an important source of boron, which plays a role in the prevention of osteoporosis. And no one can argue that they do not relieve constipation.
Avoiding sugars
Eating sugar raises blood sugars. When blood sugars are high, the central nervous system signals the digestive tract to absorb sugars more slowly. This slows down the passage of food through the digestive tract, giving gas time to accumulate and maximizes the amount of time irritating food allergens are in contact with the intestinal wall. Some naturopathic physicians speculate that sugar consumption is the most important contributing factor to spasmodic constipation in most cases in the United States.
People who have frequent constipation can avoid the urge to pass gas by cutting down on saturated fats. Fat in any form, whether it is animal fat or plant fat, is a strong stimulus for contractions of the colon after eating. Colon contractions create a strong urge to have a bowel movement, but having the bowel movement is very difficult or even impossible because the stool is very hard. Gas, however, escapes. Cutting down on fat relieves constipation and stops flatulence.
Maintaining the colon’s supply of the friendly bacterium Lactobacillus is a helpful adjunct to all other treatments. Herbal stimulant laxatives such as aloe, buckthorn, cascara sagrada, frangula, rhubarb root, and senna contain complex sugars that have to be broken down by Lactobacillus before they can stimulate movement of the muscles lining the colon. Lactobacillus also breaks down fatty acids into forms that draw more water into the colon, softening the stool and making bowel movement easier.
How do you put all this advice together in your diet plan? The basic rules are to eat your veggies and drink the often-recommended eight glasses of water a day. Beyond that, try some prunes, eat a little yogurt. Don’t pass any opportunity to eat vegetables that are served to you. Designing entire meals to treat constipation is, however, a little too much. Constipation is an important health issue, but it's not the only health issue in during recovery from cancer.
