Among the tumor patients receiving chemotherapy, about 16%-48% have this easily overlooked symptom that may be far more serious than expected - chemotherapy-related constipation (CIC) [1]. Chemotherapy-related constipation, as the name suggests, is an adverse reaction in the dige

Among the tumor patients receiving chemotherapy, about 16%-48% have this and are easily overlooked. In fact, the consequences may be far more serious than imagined - chemotherapy-related constipation (CIC) ^[1].

Chemotherapy-related constipation, as the name suggests, is an adverse reaction to the digestive tract system caused by chemotherapy drugs or chemotherapy adjuvant drugs, characterized by prolonged stool interval, hardened stool, and change in shape, ^[1].

Some people may say, constipation is too common, it’s no big deal. In fact, the impact of CIC may be more serious than you think.

If the symptoms of constipation cannot be corrected in time, it will lead to symptoms such as loss of appetite, abdominal pain, and bloating in the tumor patients, which will increase the incidence of other systemic diseases, aggravate the condition of the original disease, and have a great impact on the patient's treatment compliance and quality of life. In severe cases, intestinal obstruction, intestinal perforation, , etc., and may even endanger life-threatening ^[1].

Why do patients with tumors prone to constipation? ^[2]

In fact, there are many reasons for constipation in tumor patients. In addition to chemotherapy drugs such as vinca alkaloids, platinum, etc., the use of antiemetic drugs (especially 5-HT3 receptor antagonist antiemetic drugs), the use of opioid painkillers, long-term mental stress, strong negative psychology and emotions, long-term bed restlessness leads to reduced intestinal peristalsis, tumor compresses the intestines, long-term loss of appetite, reduced intake of cellulose and water, and changes in the living environment and defecation environment, etc., may cause constipation in tumor patients. How should

CIC be prevented and treated? ^[2-7]

1

1

0 Establish the bowel movement time according to personal habits and develop the habit of regular bowel movement. When defecation, you should concentrate and do not read books, magazines, mobile phones, and other items that will distract attention, so as to avoid distracting the attention of the bowel movement and weaken the impulse of defecation. Appropriate abdominal massage can be supplemented according to the situation to promote the development of bowel movement habits. In addition, in daily life, do not endure the stool when you feel stool and defecate in time.

2

record your defecation. If you have less than 3 times a week, you have difficulty defecation, and dry feces, you can diagnose constipation. You should seek medical treatment in time and inform the doctor of used drugs, treatments and other information in detail. The doctor will evaluate the severity of constipation and formulate corresponding treatment plans.

3

intake sufficient nutrition. On the basis of a balanced diet, try to avoid eating too fine foods, eat more foods containing soluble fiber and intestinal moistening and laxative effects, such as celery, leeks, honey, sweet potatoes, yogurt, etc., and choose a reasonable meal time according to the nature of the drug to avoid irritation of chemotherapy drugs on the gastrointestinal tract. After chemotherapy, you can choose to eat some nutritious and easy-to-digest high-fiber foods , and be careful not to drink alcohol.

4

Drinking more water during chemotherapy, and appropriately increase daily water intake without heart and renal insufficiency and other conditions, and drink 2000-3000ml of water. Intake of adequate water can not only increase the water in the intestines, but also help defecate, but also accelerate the metabolism of chemotherapy drugs.

5

If your own condition allows, you can perform moderate physical exercise under the guidance of a doctor to prevent or control constipation symptoms. You can also perform pelvic floor muscle exercises such as anal contraction and anal lifting under the guidance of a doctor to enhance your bowel movement. Bed-in patients can undergo abdominal massage, etc. with the guidance of a doctor or help.

6

If non-drug prevention and treatment measures are ineffective, you can use drug treatment as prescribed by the doctor. Currently, the main drugs to prevent and treat constipation in cancer patients include:

stool softener, also known as lubricants, such as liquid paraffin, etc.;

penetration agents, such as lactulose , sorbitol, magnesium salt , polyethylene glycol , etc.;

volumetric laxatives, such as methylcellulose , etc.;

irritating laxatives, such as senna , bisacodine, etc.

may also require enema treatment if necessary. It is necessary to remind everyone that drug treatments should be carried out under the guidance of a doctor.

7

Relieve irritability and anxiety and maintain a good mental state.

In short, cancer friends must pay attention to it. Before chemotherapy, ask the doctor whether the drugs used may cause CIC, take preventive measures, and inform the doctor in time after constipation occurs and cooperate with the doctor for treatment.

References:

[1] Ding Juan, Liu Chaohan, Yan Yujiao, et al. Summary of the best evidence for chemotherapy-related constipation in cancer patients [J]. Chinese Journal of Modern Nursing, 2020, 26(12):1550-1554. DOI:10.3760/cma.j.cn115682-20190904-03197.

[2] Jiang Li. Causes of constipation in patients with tumor chemotherapy and nursing measures [J]. Health care guide, 2021(7):182.

[3] Xia Yanyan, Zhang Jia, Yan Keli, et al. Intestinal rehabilitation training for chemotherapy-related constipation in lung cancer patients [J]. Journal of Nursing, 2019, 34(3):54-56. DOI:10.3870/j.issn.1001-4152.2019.03.054.

[4]Zhang Huimin. Application of comprehensive nursing intervention in chemotherapy-related constipation [J]. Capital Food and Medicine, 2021, 28(10):114-115. DOI:10.3969/j.issn.1005-8257.2021.10.063.

[5] Yao Xiaoyun, Chen Hongyu, Hu Jun'e, et al. Summary of the best evidence for the evaluation and management of chemotherapy-related constipation in cancer patients [J]. Acta Nursing, 2020, 27(2):48-52. DOI:10.16460/j.issn1008-9969.2020.02.048.

[6] Liu Jinman, Feng Lixia. Effect of systematic dietary nursing intervention on constipation after chemotherapy in tumor patients [J]. Journal of Nurse Continuing Studies, 2018, 33(1):62-63. DOI:10.16821/j.cnki.hsjx.2018.01.021.

[7] Gao Xiaoli, Li Hua, Liu Xingna. Analysis and treatment measures for tumor-related constipation [J]. Shanxi Medical Journal (second half of the month), 2012, 41(24): 1271-1272.

Cover and illustrations: Visual China

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Warm reminder: This article is only a popular science article and does not provide professional diagnosis and treatment opinions. For specific diagnosis and treatment, please do it under the guidance of a professional doctor.