Prevention of chemotherapy-induced constipation in patients with hematologic diseases

Author: Ren Chao Shanxi Bethune Hospital

Reviewer: Tian Weiwei, Chief Physician of Hematology Department, Shanxi Bethune Hospital

Hematological diseases include leukemia, lymphoma, multiple myeloma, myelodysplastic syndrome, etc. Chemotherapy is an important means of clinical treatment of hematological diseases. However, chemotherapy can cause certain adverse reactions. Constipation is one of the most common gastrointestinal adverse reactions in chemotherapy patients, often manifested as reduced bowel movement frequency (<3 times/week), dry stools and difficulty in defecation, mainly caused by a mixture of factors such as reduced intestinal activity and increased stool viscosity.

Previous studies have shown that the incidence of constipation in patients with blood diseases receiving chemotherapy can be as high as 50-80%. When patients are constipated, dry and hard stool passing through the intestines can easily cause rectal tearing and bleeding; during the bone marrow suppression period, it is easy to cause perianal infection and even sepsis; in addition, straining to defecate can lead to increased abdominal and brain pressure and induce cerebral hemorrhage.

At present, awareness of the prevention of chemotherapy-related constipation is relatively weak, and treatment is generally the main approach. In fact, prevention in advance is more important.

So, what are the preventive measures for constipation? Let's find out together.

1. Self-assessment and monitoring to find the cause of constipation

Conduct self-assessment and monitoring of constipation symptoms:

Observe and record daily bowel movements within 1 week after chemotherapy, including frequency, color, nature, and any abnormal bowel movements. If you experience difficulty in defecation, dry stools, or have not had a bowel movement for 3 days or more, you should inform your doctor immediately.

Find the cause in time:

When constipation occurs, the cause of constipation should be found out in time. If necessary, a physical examination including abdominal examination, perineal examination, rectal examination and abdominal X-ray examination should be performed.

2. Master the correct defecation posture and develop regular defecation habits

1. Master the correct defecation posture:

(1) For bedridden patients, the head of the bed can be raised 20° to increase comfort; the defecation environment should be kept private and screens should be used to prevent deliberate suppression of the defecation reflex and reduction of the number of bowel movements, thereby inducing or aggravating constipation.

(2) When the patient is able to sit, the correct defecation posture is half squatting, ensuring that the knees are higher than the hips and the anorectal angle is fully open. When using a toilet or commode chair, this can be achieved by using a small footstool.

3. Develop the habit of regular bowel movements:

Regular bowel movements can help the body establish a good defecation reflex. It is recommended that you try to defecate every morning regardless of whether you have the urge to defecate or not, for 3 to 5 minutes each time. You can also choose to perform bowel training after meals or before going to bed according to your own habits.

3. Abdominal massage and sitting bath after defecation

1. Abdominal massage:

After urinating, lie flat on the bed, rub the palms together to warm them up, and then overlap them and place them on the right lower abdomen, making sure that the abdomen sinks 1 to 3 cm, and do a clockwise circular massage along the ascending colon-transverse colon-descending colon-sigmoid colon to promote intestinal peristalsis. Do this once every three meals, one hour after each meal, for 10 to 15 minutes each time.

2. Perianal bath:

Take a warm water bath for 15 minutes before going to bed. The temperature of the bath should be kept between 36℃ and 42℃. Empty your bowels and bladder before taking a bath, and clean your hands and anus. During the bath, effectively contract your anus. The specific method is to take a deep breath and contract your anus at the same time for 3 to 5 seconds, then exhale and relax your anus at the same time. Repeat 10 times.

4. Dietary guidance

(1) Eat more foods rich in dietary fiber, such as sweet potatoes, leeks, corn, celery and apples, pay attention to vitamin supplements, and avoid foods that are too refined.

(2) You can eat some foods that have a laxative effect, such as honey, bananas, etc.

(3) Choose light, low-fat foods, avoid fried, grilled, spicy foods, and do not drink strong tea, cola, or coffee.

(4) Choose a reasonable meal time on the day of chemotherapy. It is recommended to eat two meals a day and avoid eating 2 to 3 hours before chemotherapy drugs. Quantify the patient's food intake before gastrointestinal reactions occur after chemotherapy.

(5) Ensure daily water intake is 3000 mL or more.

5. Exercise Guidance

1. Patients whose condition allows them to get out of bed can take appropriate walks under the guidance of a nurse, each walk should not exceed 20 minutes, and should not feel tired.

2. For patients whose condition does not allow them to get out of bed, they should lie in bed in supine position and do abdominal exercises, that is, tighten the abdomen for 10 seconds, relax it, and then tighten it again. Repeat the above exercises 10 times, 4 times a day, to enhance the patient's abdominal muscle tone and intestinal motility, and achieve the purpose of stimulating defecation.

6. Medication Guidance

Drug prevention:

1. Cancer patients receiving opioid analgesics should use laxatives prophylactically as directed by their doctor unless there are pre-existing contraindications for diarrhea.

2. For patients receiving vinca alkaloids, use laxative softeners prophylactically as directed by the doctor.

Traditional Chinese Medicine Method:

For example, auricular acupoint pressure therapy and Shenque acupoint application therapy can be used to prevent chemotherapy-related constipation.