Constipation in children with cancer--infrequent and/or difficult bowel movements--can be caused by a number of factors. The most common causes are the cancer itself, cancer treatment, medications, diet, dehydration, and lack of physical movement.

Constipation must be treated. Don't hesitate to ask your health care team for advice about the best ways to help your child. The hospital's registered dietician can be especially helpful in recommending foods for your child to eat to promote healthy bowels. Generally, avoid home remedies, experiments with laxatives, or the use of an enema, unless you are specifically instructed to do so by your child's health care team.

Let your health care professionals know at once if your child goes two days without a bowel movement, or if your child's constipation is accompanied by nausea or other troubling symptoms, such as blood in stool or in the rectal area.

Constipation should never be ignored. Left unmanaged, constipation is both very painful and dangerous to your child's health, sometimes leading to serious complications.

Symptoms

The National Cancer Institute patient materials describe constipation symptoms this way:

• No regular bowel movement for three days
• Straining on the toilet
• Small, hard stools that are difficult to pass
• Urge to strain, feelings of rectal pressure, abdominal fullness, or bloating
• Stomach aches or cramps
• Vomiting and nausea
• Abdomen appears swollen or distended
• Passing an excessive amount of gas or belching frequently
• Leakage of small amounts of soft stool resembling diarrhea.

If your child has one or more of these symptoms, he should be treated.

Prevention

The best way to avoid constipation in your child is to take action steps to prevent it. Here are steps for you and your child:

1. Drink plenty of fluids. Fluids help keep stool soft. Encourage your child to drink water and fruit juices, such as pasteurized apple juice or other favorites. If possible, avoid juices that are mostly water and sugar. Whole fruit juices contain more fiber and healthy nutrients. Hot liquids can also be helpful in promoting bowel activity.

2. Exercise helps by keeping the intestinal tract working properly. Encourage your child to have some exercise or physical activity whenever possible.

3. Keep a record of your child's daily bowel movements. This information can be very useful to the health care team in exploring ways to relieve constipation.

4. Eat fiber every day. Try whole grain cereal, including bran cereal; brown rice, dried fruits like raisins, apricots and prunes, and raw, washed fresh vegetables and fruit and nuts.

5. Take preventive measures if your child is taking an opioid-based pain medication; ask your health care professional if you aren't sure. A bowel regimen for all patients taking opioid-based pain medications is recommended by the National Cancer Institute. Opioid-based pain medications can slow down the action in the intestinal tract.

6. Encourage your child to make a bowel movement at approximately the same time every day. This can encourage a daily routine. However, don't let your child attempt to force a bowel movement just because "it's time."

Make sure to discuss your child's pain medications and possible impact on constipation with the health care team, preferably before your child begins taking opioid-based pain medication.

Treatment

Your health care team will want to know what your child's normal bowel habits are, what she eats, drinks, about the use of laxatives, exercise and about all medications being taken. There may also be physical examination, including a digital rectal examination. This is done to determine whether or not your child may have a fecal impaction (stool hardened and collected in the rectum).

The next steps recommended by your health care team will probably include all of the prevention steps listed above, and perhaps your physician will recommend medication to help, as well. These might include stool softeners, or a stool softener and a stimulant laxative, especially if your child is taking opioid-based pain medicine. It is likely that you will be directed to use a specific amount of softener and/or laxative such as Colace or Ducolax to start, and the dosage will be adjusted until the constipation is well-managed. If your child develops diarrhea, stop the medications, and let your health care team know. In some cases, the health care team may recommend the use of a rectal suppository or an enema. If the medication and treatment prescribed is not effective within a day, ask for additional assistance.

Caution: cancer patients should never use an enema or suppository without specific instructions from your health care provider.

Questions for Your Doctor

In treating constipation, your health care team may include an oncologist, registered dietician and nurse.

1. What information can I provide to help you in managing my child's constipation?

2. Might any of the medications prescribed for my child cause constipation? What is the best way to manage this?

3. What exercises do you recommend for my child?

4. How much dietary fiber is right for my child? What foods are high in fiber?

5. If my child needs a stool softener and /or a laxative because of some of the mediations being taken, what are your specific recommendations?

6. Are there any symptoms or reactions to treatment for my child's constipation that should prompt me to call you immediately?

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