Constipation refers to bowel motions that are too hard, too small, too difficult to expel and too infrequent.

Normal bowel habits may vary from every day to every second or third day. Not having a bowel movement every day doesn’t necessarily mean you are constipated. It’s important to know what is normal for you and what isn’t.

There are a number of disease and treatment-related factors which can cause constipation. They can include:

• obstruction, pressure or nerve damage caused by your cancer
• some chemotherapy drugs, including vinca alkaloids and thalidomide
• some anti-nausea drugs you may be given as part of your treatment
• other medications you may be taking, such as iron supplements, antihypertensive agents and pain medication
• reduced mobility and lack of exercise
• poor nutritional status – low fibre diet and inadequate fluid intake
• older age
• changes in lifestyle or routine – lack of privacy may be a cause

Your health professionals will talk to you about whether you’re at risk of constipation. Here are some strategies which can help you prevent constipation:

• Increase your water intake – you should drink two to three litres a day. Prune, apple or pear juice can also help
• Increase the amount of food you eat that is high in fibre (for example, wholegrain breads and cereals, fruits and vegetables, beans, legumes and lentils). Consider talking to a dietitian who can support you to manage your diet
• Increase physical activity, if you are able
• Take preventative laxatives as prescribed
• Try to establish a regular bowel routine with privacy and comfort
• Report any symptoms of constipation to your health professional

If your bowels do not open after three days, you should start a bowel management plan which may include stimulant laxatives, stool softeners, osmotic agents and/or suppositories and enemas. This plan will be developed in collaboration with your doctor. Although many of these medications are available without a prescription, it’s important to talk to your care team before taking any medication.

Constipation becomes a problem when it leads to other complications such as haemorrhoids or bowel blockages. It’s very important that you talk to your care team if you experience excessive pain or bleeding from the rectum. When your white cell count or platelet counts are low, constipation can result in a higher risk of infection and/or bleeding so you should report any signs of constipation early.