Abdominal Distension and Constipation in Terminal Cancer Patients

Q: Abdominal Distension and Constipation in Terminal Cancer Patients

Hello： I am very sorry to read your account. <br>Treatment often does not end as satisfactorily as we hope. <br>If I were your attending physician, I would increase the dosage and potency of morphine. <br>You should know that the analgesic effect of morphine has no upper limit; i

Abdominal swelling and hardness in terminal cancer patients, along with persistent urges to defecate without being able to do so, may be due to several factors. These can include bowel obstruction, which is common in advanced cancer due to tumor growth or adhesions; constipation resulting from reduced mobility, dehydration, or medication side effects; or ascites, which is the accumulation of fluid in the abdominal cavity. It is important for patients

Hello Doctor, my mother is in the advanced stage of endometrial cancer.
After over four years of aggressive treatment for localized cancer, it has metastasized.
She has undergone a hysterectomy and has had chemotherapy and radiation therapy twice each.
Now, we have opted for home hospice care.
She is quite overweight, nearly 100 kilograms, and is currently experiencing full-body weakness and can only consume liquid food.
However, she often feels abdominal pain and the urge to have a bowel movement.
She has been taking stool softeners but still feels incomplete after bowel movements.
While she feels a bit better after going, she continues to have frequent urges with only small amounts of loose stools.
The hospital mentioned that there were medications to treat these symptoms, but the pharmaceutical company has gone out of business, so those treatments are unavailable.
They only suggested using weak opioids for pain relief.
Her abdomen is swollen, large, and hard, but the doctor has stated that it is not ascites.
I would like to ask you what might be causing this and if there are any ways to alleviate my mother's abdominal pain and persistent urge to defecate.
We have been trying abdominal circular massages, but the effect has been minimal.
Is it only possible to rely on pain medication?

Zhu Zhu Ni, 20~29 year old female. Ask Date: 2016/03/06

Dr. Chen Yunfang reply Oncology

Hello: I am very sorry to read your account.
Treatment often does not end as satisfactorily as we hope.
If I were your attending physician, I would increase the dosage and potency of morphine.
You should know that the analgesic effect of morphine has no upper limit; it can be gradually increased until the patient no longer reports pain (if oral administration is not feasible, fentanyl patches can be used, which are comparable to morphine).
Additionally, the side effects of morphine can cause constipation and slow down gastrointestinal motility (which is precisely what you are concerned about and hoping to address, right?).
Therefore, increasing morphine can provide both pain relief and alleviate constipation, which can be beneficial! However, I would still honestly inform my patients that morphine may cause increased drowsiness and lethargy, and that the time to say goodbye will eventually come.
Nevertheless, at this stage, it is not about the duration of time but rather the quality of life and comfort in the end, which I believe is what truly matters.
Thank you for your understanding!

Reply Date: 2016/03/06

More Info

Understanding abdominal distension and constipation in terminal cancer patients is a complex issue that often arises due to multiple factors related to the disease itself and its treatment. In your mother's case, she is experiencing significant discomfort due to her advanced endometrial cancer, which has led to a series of complications that can affect her gastrointestinal function.

Causes of Abdominal Distension and Constipation
1. Tumor Pressure: As tumors grow, they can exert pressure on surrounding organs, including the intestines. This pressure can lead to obstruction or decreased motility, resulting in constipation and abdominal distension.

2. Reduced Mobility: Patients with terminal cancer often experience fatigue and weakness, leading to decreased physical activity. Reduced mobility can slow down gastrointestinal motility, making constipation more likely.

3. Dietary Changes: Your mother is currently on a liquid diet, which may not provide enough fiber to promote regular bowel movements. While liquid diets can be easier to digest, they may not stimulate the intestines as effectively as solid foods.

4. Medications: Opioids, which are often prescribed for pain management in terminal cancer patients, can cause constipation as a side effect. This is due to their action on the opioid receptors in the gut, which slows down bowel movements.

5. Fluid Retention: Although the doctors have ruled out ascites (fluid accumulation in the abdominal cavity), other forms of fluid retention or changes in body composition due to cancer can lead to a feeling of fullness and abdominal distension.

Management Strategies
1. Medication Adjustments: Since your mother is experiencing constipation, it may be beneficial to discuss with her healthcare provider the possibility of adjusting her pain management regimen. While opioids are effective for pain relief, they can exacerbate constipation. Alternatives such as non-opioid analgesics or adjuvant medications (like gabapentin or certain antidepressants) may be considered.

2. Laxatives and Stool Softeners: Over-the-counter laxatives or stool softeners can be helpful. However, it’s crucial to consult with her doctor to find the right balance, especially since she is already on medication for pain.

3. Dietary Considerations: If possible, incorporating high-fiber liquids or supplements may help. Products like psyllium husk can be mixed into liquids to increase fiber intake, which can promote bowel regularity.

4. Hydration: Ensuring adequate fluid intake is essential, as dehydration can worsen constipation. If she is able to tolerate it, increasing her fluid intake may help.

5. Gentle Abdominal Massage: While you mentioned that abdominal massage has had limited effects, it can still be beneficial. Gentle, circular motions can stimulate bowel activity. Additionally, positioning her in a way that promotes comfort and relaxation may help.

6. Palliative Care Consultation: Engaging a palliative care team can provide additional support. They specialize in managing symptoms and improving quality of life for patients with serious illnesses. They can offer tailored strategies for managing pain, constipation, and overall comfort.

7. Emotional Support: The psychological aspect of dealing with terminal illness can also affect physical symptoms. Providing emotional support and ensuring she feels comfortable discussing her symptoms can be beneficial.

Conclusion
In summary, your mother's symptoms of abdominal distension and constipation are likely multifactorial, stemming from her cancer, treatment, and overall health status. A comprehensive approach that includes medication management, dietary adjustments, and supportive care can help alleviate her discomfort. It is essential to maintain open communication with her healthcare team to ensure that her symptoms are managed effectively and compassionately.

Similar Q&A

Understanding Post-Surgery Abdominal Distension in Elderly Patients

(1) It is possible for your father to have a paralytic ileus, especially since he has undergone surgery recently. This condition can occur after surgery due to decreased bowel motility. (2) Given his history of traditional surgery for gallstones, if there is an adhesive bowel ob...

Dr. Yu Mingchang reply Surgery
Hello: As we age, paralytic ileus is quite common and requires gastrointestinal care. The surgical team at Changhua Hospital is here to support you.

Understanding Chronic Gastritis, IBS, and Colorectal Cancer Symptoms

Hello Doctor: I have a long-standing condition of chronic gastritis, and you have previously suspected the possibility of irritable bowel syndrome. Symptoms such as belching and burping have persisted for quite some time. I used to experience periods of constipation, followed by ...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: In terms of age, the likelihood of you developing colorectal cancer is quite low. My suggestion is to adjust your lifestyle, manage stress, and improve your dietary habits, along with engaging in regular exercise. However, if you experience significant weight loss or recta...

Post-Surgery Probiotic Use for Constipation Relief in Seniors

Hello Doctor, I would like to explain my grandfather's situation. He is 83 years old. In early July, he experienced difficulty with bowel movements. After seeing a doctor, he was diagnosed with "C187 malignant tumor of the sigmoid colon." He later underwent surger...

Dr. Ke Fangxu reply Surgery
1. Theoretically, probiotics and laxatives should not have an impact on each other, and adjustments can be made based on bowel movement status. 2. Products that contain chicory may even enhance the effects of intestinal probiotics. 3. 4. It should be possible.

Managing Bowel Narrowing After Cancer Treatment: Tips and Solutions

My mother underwent surgery for rectal cancer seven years ago, and she started receiving radiation therapy and chemotherapy last year. Recently, she has been experiencing abdominal distension, cramping, and difficulty with bowel movements. Last week, she was hospitalized for exam...

Dr. Liang Jiade reply Gastroenterology and Hepatology
Hello, patients who have undergone surgical radiation therapy often experience intestinal adhesions. Conditions such as bowel stricture and intestinal obstruction, as well as radiation enteritis, can occur. It is advisable to maintain regular bowel habits to prevent constipation ...