This week's artwork was donated by Lonny, a pediatric cancer patient who received treatment at The Children's Hospital of Philadelphia . Constipation can be a presenting symptom of cancer, or it can occur later as a side effect of a growing tumor or treatment of the tumor. Any or all of these factors can occur because of the disease process, aging, debilitation, or treatment. Since constipation is common with the use of narcotics, a bowel regimen should be initiated at the time narcotics are prescribed and continued for as long as the patient takes narcotics.
Narcotics produce varying degrees of constipation, suggesting a dose-related phenomenon.
Metabolic disorders such as hypokalemia and hypercalcemia also predispose cancer patients to developing constipation. Once these disorders are corrected, constipation should subside. A thorough history of the patient's bowel pattern, diet changes, and medications along with a physical examination can identify possible causes of constipation. The evaluation should also include assessment of associated symptoms such as distention, flatus, cramping, or rectal fullness. A digital rectal examination should always be done to rule out fecal impaction.