Constipation
Constipation is excessive straining with the uncomfortable or painful passage of irregular, infrequent, or
hard feces. It has been reported as ranging in incidence from 50-95% in the oncology population.
Refer to Appendix A for the Rome III diagnostic criteria for constipation.
Causes
Patients receiving opioids experience the highest incidence of constipation.
Constipation may occur due to the pathology of and/or treatment of cancer (e.g. cytotoxic agents,
specifically the vinca alkaloids). Patients with diseases of the colon, hypercalcemia, pressure to the bowel
from ascites, metastasis or neurogenic causes secondary to the disease process (e.g. cord compression at
the T8 to L3 level) can develop constipation.
Adverse effects from disease such as limited food intake, dehydration and/or immobility may cause
constipation.
Prevention
Preventative measures include the prophylactic use of laxatives and also lifestyle modifications, including
increasing fluid and fiber intake, increasing physical activity, and developing a toileting regimen.
Refer to Patient Education on Constipation and Management of Constipation.
Assessment
The responsibility of the Oncology Triage Nurse is to gather all necessary information and develop a
treatment plan, consulting providers as appropriate.
The assessment priority is to identify symptoms indicative of an emergency. If an emergency is possible,
the nurse should page the MD/APP for instruction.
Refer to Nurse Triaging for Constipation for a detailed assessment plan and triage instructions.
CLIENT acknowledges that the Via Pathways and Via Pathways Portal are information management tools only, and that Via Oncology, LLC has not represented the Via
Pathways or Via Pathways Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The
clinical information contained in the Via Pathways and Via Pathways Portal is intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and
judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.
Updated: 9/2014
© 2015 Via Oncology, LLC.
Treatment
The primary pharmacologic intervention is the use of laxatives.
Reinforce patient education regarding self-management of constipation.
Refer to Management of Constipation for a detailed treatment algorithm.
Citations
Cherwin,C. (2012). Gastrointestinal symptom representation in cancer symptom clusters: A synthesis of the literature. Oncology
Nursing Forum, 39 (2) ,157-165.
Chung-Wah, C. (2012). A cross-sectional study of constipation and laxative use in advanced cancer patients: Insights for revisions
of current practice. (2012). Support Care Cancer. DOI: 10.1007/s00520-012-1504-x.
Ducrotte, P., & Causse, C. (2012). The bowel function index: a new validated scale for assessing opioid-induced constipation.
Current Medical Research and Opinion, 28 (3), 457-466.
Ford, A.C., Brenner, D., & Schoenfeld, P.S. (2013). Efficacy of pharmacological therapies for the treatment of opioid-induced
constipation: Systematic review and meta-analysis. The American Journal of Gastroenterology, doi:10.1038/ajg.2013.169.
Fritz, D. & Pitlick, M. (2012). Evidence about the prevention and management of constipation. Implications for comfort. Part 1.
Home Healthcare Nurse. 30(9), 534-540.
Gatti, A., & Sabato, A.F. (2012). Management of opioid-induced constipation in cancer patients: Focus on methylnaltrexone. Clinical
Drug Investigations, 32(5), 293-301.
McMillan, S. C., Tofthagen, C., Small, B., Karver, S., & Craig, D. (2013, May). Trajectory of medication-induced constipation in
patients with cancer. Oncology Nursing Forum, 40(3), E92-E100.
Obokhare, I. (2012). Fecal impaction: A cause for concern? Clinics in Colon and Rectal Surgery, 25(1), 53-57.
Pitlick, M. & Fritz, D. (2012). Evidence about the pharmacological management fo constipation, Part 2: Implications for palliative
care. Home Healthcare Nurse. 31(4), 207-216.
Twycross, R., Sykes, N., Mihalyo, M., & Wilcock, A. (2012). Therapeutic reviews: Stimulant laxatives and opiod-induced
constipation. Journal of Pain and Symptom Management, 43(2), 306-313.
Woolery, M., Bisanz, A., Lyons, H., Gaido, L., Yenulevich, M., Fulton, S., & McMillan, S.
(2007). Putting evidence into practice: Evidence – based interventions for the prevention and management of constipation in
patients with cancer. Clinical Journal of Oncology Nursing, 12(2), 317-337.
CLIENT acknowledges that the Via Pathways and Via Pathways Portal are information management tools only, and that Via Oncology, LLC has not represented the Via
Pathways or Via Pathways Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The
clinical information contained in the Via Pathways and Via Pathways Portal is intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and
judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.
Updated: 9/2014
© 2015 Via Oncology, LLC.
Appendix A
Diagnostic criteria* for constipation1:
1. Must include two or more of the following:
a. Straining during at least 25% of defecations
b. Lumpy or hard stools in at least 25% of defecations
c. Sensation of incomplete evacuation for at least 25% of defecations
d. Sensation of anorectal obstruction/blockage for at least 25% of defecations
e. Manual maneuvers to facilitate at least 25% of defecations (e.g., digital evacuation, support of the
pelvic floor)
f. Fewer than three defecations per week
2. Loose stools are rarely present without the use of laxatives
3. Insufficient criteria for irritable bowel syndrome
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
1
Adapted from the Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders
http://romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf
CLIENT acknowledges that the Via Pathways and Via Pathways Portal are information management tools only, and that Via Oncology, LLC has not represented the Via
Pathways or Via Pathways Portal as having the ability to diagnose disease, prescribe treatment, or perform any other tasks that constitute the practice of medicine. The
clinical information contained in the Via Pathways and Via Pathways Portal is intended as a supplement to, and not a substitute for, the knowledge, expertise, skill, and
judgment of physicians, pharmacists and other healthcare professionals involved with patient care at CLIENT facilities.
Updated: 9/2014
© 2015 Via Oncology, LLC.