End of Life Concerns Pain & Symptom Control Constipation in Chronically Ill Patients By Angela Morrow, RN Angela Morrow, RN LinkedIn Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. Learn about our editorial process Updated on February 23, 2023 Medically reviewed by Jason DelCollo, DO Medically reviewed by Jason DelCollo, DO Jason DelCollo, DO, board-certified in family medicine. He is associate faculty at Philadelphia College of Osteopathic Medicine as well as adjunct faculty with the Crozer Family Medicine Residency Program, and is an attending physician at Glen Mills Family Medicine in Glen Mills, Pennsylvania. Learn about our Medical Expert Board Fact checked by Marley Hall Fact checked by Marley Hall LinkedIn Marley Hall is a writer and fact checker who is certified in clinical and translational research. Her work has been published in medical journals in the field of surgery, and she has received numerous awards for publication in education. Learn about our editorial process Print Constipation is a decrease in the frequency of passage of well-formed stools and is characterized by stools that are hard and small and difficult to expel. It's a subjective condition, differing for individuals based upon their normal pattern of bowel movements and their symptoms of discomfort. It can be caused by anything that slows down the motility of the gut or obstructs the intestines. Constipation occurs frequently in patients near the end of life. Cancer patients may have the highest prevalence, with as many as 70 to 100% of patients experiencing constipation at some point during their disease. This condition affects a patient's quality of life substantially. It causes physical, social, and psychological distress for patients, which can impact their caregivers as well. ljubaphoto / Getty Images Symptoms The first sign of constipation is a decrease in the frequency and amount of bowel movements. Patients and their caregivers will sometimes attribute this decrease to a reduced intake of food or fluids. Because constipation is subjective, what it means for one patient may be different for another. For example, if a patient usually has a bowel movement every day and suddenly starts having them three times a week, constipation should be considered. If, however, a patient normally has a bowel movement every other day, going two or three days without one might not be a problem. Other signs of constipation include bloating, abdominal distention, a change in the amount of gas passed, oozing liquid stool, rectal pain or pressure, rectal pain with bowel movements, and the inability to pass stool. If constipation has been untreated for some time, nausea and vomiting may also occur. Causes Constipation may be caused by the disease. Cancer-related constipation can be caused by tumors in or near digestive organs, the spine, or the pelvic region. The tumors may compress or obstruct the bowel or slow the motility of the intestines. Neurological diseases, such as Parkinson's, MS, and ALS, sometimes interfere with gastric motility. Diabetes can cause neuropathy, leading to decreased movement in the colon. Other pathological conditions of the endocrine system can also cause constipation. Hypothyroidism is one such condition. Lifestyle changes such as decreased appetite and fluid intake may lead to hypercalcemia, or an increase in calcium in the blood, which can, in turn, lead to decreased water absorption in the bowel, causing constipation. Weakness and decreased activity affect the ability to use abdominal wall muscles and to relax the pelvic floor muscles, which are essential for proper elimination. Medications may also be to blame for constipation. Opioid analgesics, such as morphine and oxycodone, slow down the motility of the gut by suppressing forward peristalsis and increase the tone of the anal sphincter. Opioids also increase the absorption of water and electrolytes in the large and small intestine, leading to hard, dry stools. Other medications that may contribute to constipation include: Vinka alkaloid chemotherapy such as Velban (vinblastine) Anticholinergic drugs like Phenergan (promethazine) Tricyclic antidepressants such as Paxil (paroxetine) Antiparkinsonian drugs including levodopa Iron supplements Antihypertensives (high blood pressure medication) Antihistamines like Benadryl (diphenhydramine) Antacids Diuretics including Lasix (furosemide) How Can I Prevent or Treat Constipation? Effective constipation prevention is based on adequate fluid intake, a proper diet, and physical activity (being active motivates the bowels). 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Mercadante S, Masedu F, Maltoni M, et al. The prevalence of constipation at admission and after 1 week of palliative care: a multi-center study. Current Medical Research and Opinion. 2018;34(7):1187-1192. doi:10.1080/03007995.2017.1358702 Hu A, Yamaguchi T, Ikarashi Y, Tabuchi M, Kobayashi H. Patients with Chronic Constipation Experience Psychological Stress as Measured by the Poms2 Test and Salivary Stress Markers. Social Science Research Network; 2021. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Constipation. Camilleri M. Gastrointestinal motility disorders in neurologic disease. Journal of Clinical Investigation. 2021;131(4):e143771. doi:10.1172/JCI143771 Patil AD. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian J Endocrinol Metab. 2014 May;18(3):307-9. doi:10.4103/2230-8210.131155 Ragno A, Pepe J, Badiali D, Minisola S, Romagnoli E, Severi C, D'Erasmo E. Chronic constipation in hypercalcemic patients with primary hyperparathyroidism. Eur Rev Med Pharmacol Sci. 2012 Jul;16(7):884-9. Turkoski BB. I Can't Poop": Medication-induced constipation. Orthop Nurs. 2018 May/Jun;37(3):192-196. doi:10.1097/NOR.0000000000000450 Leppert W. The impact of opioid analgesics on the gastrointestinal tract function and the current management possibilities. Contemp Oncol (Pozn). 2012;16(2):125-31. doi:10.5114/wo.2012.28792 By Angela Morrow, RN Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit