Inspired Momx1

Friday, August 21, 2009

Chemotherapy Induced Constipation

Mama experienced constipation right after her 1st chemo cycle's drug infusion and from taking of pre and post chemo anti-nausea drugs such as Granisetron (Kytril), Ondansetron (Zofran) and Dexamethasone (Decadron). The first two anti-nausea drugs could well be the culprit for the constipation as this was one of the common side effects.

Mama did not have bowel movement until the next day when she noticed bright red blood in her stool. That scared the hell out of us as she told us that the toilet bowl was actually all red when she looked into it.

I have added a lot of high fibre food in mom's daily diet and kept reminding her to take lots of fluids as constipation was anticipated in patients undergoing chemotherapy but blood in the stool was not common though.

I quickly looked up on the internet and found some useful information:

  1. Hemorrhoids (also called piles) - Enlarged veins in the lower part of the rectum or anus

  2. Anal fissures - Small cracks or tears around the anus which can be caused by forceful or large bowel movements

  3. Infection or disease in the GI (gastrointestinal tract) - Bacterial infections, stomach ulcers, or inflammatory bowel disease (IBD).

  4. Tumors or cancer of the GI tract - Polyps or colon cancer. Cramps in relation to bright red rectal bleeding are suggestive of a partial colonic obstruction and especially suggest cancer.
Passing bright red blood usually suggests that the blood is coming from the large bowel or the rectum.

Hemorrhoids can be internal or external and are often caused by struggling when trying to defecate. You can't always feel them, and they don't always hurt when you sit. Mom felt straining around the anus during bowel movement and this suggested hemorrhoid.

Point 3 was ruled out because mom did not have any pain or dizziness from the bleeding.

I took mom back to the oncology clinic and Dr Lim, the MO on duty, performed a anoscopy on her. During the anoscopy, the doctor used a short, rigid, hollow tube (anoscope) and a nurse assisting him holding a torch light to look at the last 2" of mom's colon (anal canal). According to the dr, anoscopy can be done at any time because it does not require any special preparation (enemas or laxatives) to empty the colon.

The doctor told me that he noticed some enlarged veins in the lower part of mom's rectum and it could be due to internal hemorrhoid where the patient herself could not feel and did not even realise its presence. He wanted me to mention this during the follow-up appointment with mom's surgeon in two weeks' time to perform another anoscope to confirm his findings.

I asked for some stool softeners to help mom in bowel movements and the doctor prescibed Lactulose. Lactulose works by increasing the water content and volume of the stools in the bowel, making them softer and easier to pass. It is made up of sugar molecules and is broken down by the bacteria that live in the lower part of the gut. This leads to the contents of the gut becoming more acidic, which reduces the absorption of a chemical called ammonia. The presence of ammonia in the gut causes water to be drawn into the lower bowel. This increases the amount of water in the stools, softening them and making them easier to pass, thus relieving constipation. It can take up to 48 hours for the lactulose to have an effect.

I bought a bottle of Del Monte prune juice just before mom started her 2nd chemo cycle. She has been taking half a cup of prune juice together with 1 teaspoonful of L-Glutamine powder (known for prevention of neuropathy which I intend to blog about it later) twice a day on empty stomach since a day prior to her 2nd cycle and it has been a week now and the result was fantastic. She has not missed her daily bowel movement and has not have blood in her stool till now (knock on wood). She also took two teaspoonfuls of psyllium husk with her whey protein powder twice daily to prevent constipation even before the start of the 1st chemo cycle but it did not help as much.

We now swear by prune juice for mom's constipation and she now takes it obediently without much grumbles despite initially complaint of its nasty taste.

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Blogger Health Freak Mommy said...

So sorry to read that your mom has cancer. I swear by psyllium husk and red dragon fruit to beat constipation. Hot green tea works like a charm too in beating constipation. Green tea is also high in antioxidant and I drink a cup every single day. Maybe you can let your mom try hot green tea.

August 21, 2009 at 3:29 PM  
Blogger Inspired Momx1 said...

Hi, Health Freak Mommy, thanks for your tips. I have not tried hot green tea yet and maybe I should give it a try. My mom has stopped eating anything red eg beet root and dragon fruit for fear of having problem identifying if it is indeed blood in her stool or from the fruits she consumes.

August 21, 2009 at 4:36 PM  

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