Healing Nutrition

Constipation occurs when a person has difficulties emptying the large bowel. As stated by the NIH, bowel movements become less frequent, and stools become hard, dry, and difficult to pass.

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According to a 2017 Journal of the Advanced Practitioner in Oncology article, constipation is a common and distressing problem for people with cancer, occurring in almost 60% of patients. 

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You may have painful movements, feel bloated, or have nausea. You may burp, pass much gas, and have stomach cramps or pressure in the rectum. 
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When a person poops only 3 or fewer times per week may have constipation. It is important to report to your doctor or dietitian if you haven’t had a bowel movement for more than 3 days. 

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Constipation is a common complaint that may be due to a variety of causes. Some pain medicines and chemotherapy drugs commonly cause constipation; this can be a problem at any time during your treatment.

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A diet high in fiber promotes regular bowel movements, especially with adequate hydration.

 

Dietary fiber, especially insoluble fiber, helps prevent constipation by increasing stool weight and accelerating intestinal transit. Based on a 2022 literature review, eating a diet high in fiber also promotes more health benefits, including a decreased risk of heart disease, stroke, and type 2 diabetes.

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Nutrition Strategies for Constipation

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• Drinking enough fluids. Drink plenty of fluids. Set a goal of at least 8-10 cups per day. You may need even more with higher amounts of fiber. 

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• Some warm choices might help stimulate bowel movements, like hot teas, hot cereals, and hot water with lemon juice and honey.

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• Slowly increase the amount of fiber that you eat. Over a few days, you should increase fiber by no more than 5 grams daily until you reach a goal of 25 to 35 grams of fiber daily.

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• Drink an additional 32 oz. of fluid daily if using medicinal fibers.

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• Dry plums, also known as prunes, are an excellent natural remedy due to their fiber and sorbitol content. Sorbitol is an alcohol sugar, and for some people, the body cannot digest and acts like a laxative by pulling water into the intestines. ​

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• Incorporate food rich in probiotics to help with constipation.

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• Be active each day if possible – even 5-10 minutes several times a day can help the digestive system work at its best. ​

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• Schedule bathroom time every day.

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Foods to Relieve Constipation 

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Eat foods high in fiber - having as varied eating patterns as possible from the foods listed below can help relieve constipation. Foods rich in insoluble fiber add bulk and moisture to our stools and help us push our stools out more quickly. Beans, vegetables, whole grains, nuts, and seeds must predominate in a high-fiber diet.
 

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Fruits

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Fruits are great options for fighting constipation since they contain a good amount of fiber, which speeds up intestinal transit and favors the formation of stools. In addition, fruits are also rich in water, an important element that helps with constipation as well. 

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Eat fruits regularly; they are easy to include at breakfast, or eat them as a snack, lunch, and dinner, preferably fresh and with the skin.

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• Passion fruit, avocados, guavas, berries, pomegranate, kiwi, pears, oranges, cherries, apricots, bananas, starfruit, and apples

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Vegetables

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Including vegetables daily in the diet provides natural fiber, improving digestive processes and nourishing the body with many nutrients necessary for a healthy diet.

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Their high content of phytonutrients and vitamins, such as vitamin A, vitamin K and vitamin C, and minerals, such as potassium, iron, magnesium, folate, manganese, and many others, make them essential allies for disease prevention, weight loss, and heart protection diets.​

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• Acorn squash, collard greens, artichokes, butternut squash, parsnips, kale, broccoli, carrots, spinach, Brussel sprouts, green beans, okra, sweet potatoes, baked potatoes, asparagus

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Beans, Peas, and Lentils

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Beans, peas, and lentils are rich in fiber, especially cellulose, which is insoluble fiber and part of the cell wall of plants. It cannot be absorbed by the human digestive system and is eliminated in the stools. This type of fiber stimulates the intestinal tract. 

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It also has preventive effects against obesity, diabetes mellitus, constipation, and diverticulitis and lowers cholesterol levels. ​​

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• Lima, fava, garbanzo, kidney, mung, white, navy, Adzuki (red), black, pinto beans, and lentils

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• Blackeyes (cow peas), pigeon, split, and green peas

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Nuts and Seeds

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Natural, unsalted, or lightly roasted nuts and seeds contain a large amount of fiber necessary for intestinal transit. In addition, they provide healthy fats that help with bowel movements and a good amount of protein. As a bonus, chia seeds, flaxseeds, and walnuts give a boost of omega 3. 

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• Almonds, pine nuts, pistachios, hazelnuts, and pecans 

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• Chia seeds, flax seeds, pumpkin and squash seeds, and sesame seed

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Whole Grains

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Whole grains help treat and prevent constipation since they are an excellent source of fiber to increase the size of stools and soften them, making them easy to pass through the intestines.

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Whole grains have a broad nutritional profile. Generally speaking, they provide a wide variety of minerals and B vitamins. Many of these grains harbor antioxidant compounds and are also a rich source of protein. Whole grains that are gluten-free and rich in fiber are best against bloating. ​

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• Amaranth, buckwheat, teff, wild rice, quinoa, millet, oats, and sorghum

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Bran and High-Fiber Cereals

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Cereals are also rich in soluble and insoluble fiber, therefore effective in overcoming constipation. Including them in the diet regularly favors intestinal transit, reduces cholesterol, and maintains glycemic control. 

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Cereals provide a high density of nutrients like vitamins, minerals, and protein. Add toppings such as chopped fruits and nuts to get extra fiber and more nutrients. ​

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• All-Bran®, FiberOne™, Kashi®, Grape-Nuts®, Bob's Red Mill Hot Cereal, and Nature's Path Organic® (5)

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Probiotics for Constipation

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A meta-analysis of randomized controlled trials suggests that consumption of probiotics, particularly multispecies probiotics, may substantially increase stool frequency and improve stool consistency. Thus, probiotics can be considered safe and natural agents for alleviating functional constipation in adults.

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• Foods Rich in Probiotics

  • Greek yogurt, kefir, sauerkraut, tempeh, kimchi, miso, kombucha, traditional buttermilk, natto

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• Probiotic Strains

  • Bifidobacterium lactis, Lactobacillus plantarum, Streptococcus thermophilus, Lactobacillus reuteri, Bifidobacterium longum (13, 14, 15)

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Caution: bacteremia is possible in immunocompromised patients. Avoid using probiotics if you are immunocompromised. Thus, if you have any underlying health conditions, it’s best to consult a healthcare professional before taking probiotics.

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What Causes Constipation in Cancer

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Tumors in the stomach and intestines can squeeze the passageway in the small bowel for stool to pass, causing constipation. Sometimes, it can also obstruct the tract requiring urgent medical attention. 

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Chemotherapy drugs, including gemcitabine, oxaliplatin, thalidomide, vinblastine, vincristine, and nivolumab, among others, can cause constipation.  

 

Some medicines that can induce constipation include calcium, iron supplements, pain medications, and diuretics.

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Other factors like diet, aging, obesity, pregnancy, physical inactivity, not drinking enough fluids, irritable bowel syndrome, and other diseases can also cause constipation.  

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You may need a stool softener, lubricants (mineral oil), and laxatives to relieve constipation. Talk to your registered dietitian or doctor to see which option is the best for your needs.

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Foods That Can Cause Constipation 

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​Foods high in saturated fat and without fiber may be causing or worsening constipation and should be avoided. ​ 

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• Processed grains

  • White flour, white rice, white pasta, and white bread

  • Any bread, cereals, crackers, desserts, and pastries made with refined grains

• Milk and dairy products

• Red meats

• Fried or fast foods

• Persimmons, astringent variety 

• Gluten intolerance may cause constipation

• Alcohol