Bowel Issues Related to Cancer Treatments

Bowel issues such as constipation are very prevalent in cancer patients due to the cancer treatments they are receiving. Constipation in advanced cancer patients ranges between 40% and 90%,¹ and is more common in opioid-treated populations.² Prevalence of constipation in cancer patients in intensive care units, veterans’ hospitals, and hospice home care range from 43% to 80%.³ Additionally, in older cancer patients receiving palliative care, constipation is one of the most prevalent symptoms, with prevalence rates ranging between 51% and 55%.⁴

Criteria for Constipation Assessment Scale

The Constipation Assessment Scale (CAS) is an eight-item three-point rating scale that measures the presence and intensity of constipation.

Each item is rated by the patient as no problem (0), some problem (1), or severe problem (2). The items on the scale include⁵:

1. Abdominal distention or bloating
2. Change in amount of gas passed rectally
3. Less frequent bowel movements
4. Oozing liquid stool
5. Rectal fullness or pressure
6. Rectal Pain with bowel movement
7. Small stool size
8. Urge but an inability to pass stool

Treatment Related Causes of Constipation

There are numerous treatment related causes of constipation including⁷:

• Opioid Analgesics – delayed gastric emptying and increased bowel transit time
• Serotonin 5HT3 Receptor Antagonists – slow colonic transit time
• Vinca Alkaloids – prolonged GI transit time
• Thalidomide – constipation is common
• Other Constipating Medications Used in Cancer Care
  • Antidepressants
  • Antacids
  • Antispasmodics
  • Anticonvulsants
  • Antihypertensive Drugs
  • Iron Supplements
  • Diuretics

Fecal Incontinence After Rectal Cancer Treatment

Another prevalent bowel issue related to cancer treatments is fecal incontinence after rectal cancer treatment.

Fecal incontinence occurs frequently after rectal cancer treatment, affecting almost half of patients with normal preoperative functioning. Incontinence may range from inadvertent gas to minor soiling or complete rectal emptying and can lead to avoidance of certain activities, such as long-distance travel by car or plane, during which bathroom facilities may not be immediately available⁷.

Studies have indicated that following a traditional restorative resection, the most frequently reported symptom was fecal incontinence (97%)⁸. Taking a daily enema at consistent times will help control stool removal and decrease episodes of fecal incontinence⁹.

Bowel Preparation for Prostate Radiation

When it comes to prostate radiation, rectal distention is the single most important variable in causing prostate motion in the anteroposterior direction¹⁰. Patients receiving radiotherapy to the prostate can exhibit prostate shifts owing to rectoral distension that can lead to geographical miss¹¹.

Fiorino et al showed the use of daily enemas for evacuating the contents of the rectum efficiently minimized prostate motion¹².

Using ENEMEEZ® for Bowel Issues Related to Cancer Treatments

ENEMEEZ® mini enemas can benefit patients undergoing cancer treatments. ENEMEEZ® functions as a hyperosmotic stool softening laxative by drawing water into the bowel from surrounding body tissues, helping to soften and loosen the stool.

ENEMEEZ®️ is a good option for cancer patients because it addresses one of the common side effects of cancer treatment: constipation. Here’s why it is particularly beneficial:

1. Fast and Effective Relief: ENEMEEZ®️ provides prompt relief from constipation, typically working within 2 to 15 minutes. This is crucial for cancer patients, who may suffer from severe or chronic constipation due to medications, chemotherapy, or reduced mobility.
2. No Mucosal Discharge: ENEMEEZ®️ is neither an irritant nor a harsh stimulant. It helps maintain skin integrity by preventing the mucosal discharge often associated with suppositories.
3. Gentle Formula: ENEMEEZ®️ uses a docusate-based formula that softens stool and stimulates bowel movements gently, minimizing discomfort, which is especially important for patients with sensitive or compromised health.
4. Reduces Strain: The gentle action of ENEMEEZ®️ helps reduce the need for straining during bowel movements. This is important for cancer patients, particularly those recovering from surgeries or dealing with abdominal tumors, as straining can cause pain or complications.
5. Convenient Administration: ENEMEEZ®️ is easy to administer, offering a quick and straightforward solution that patients or caregivers can use at home, reducing the need for more invasive interventions.
6. Avoids Oral Medications: Since ENEMEEZ®️ is administered rectally, it is suitable for patients who have difficulty swallowing or need to avoid oral medications that could interact with their cancer treatments.

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Sources:

1. Van Lancker A, Velghe A, Van Hecke A. Prevalence of symptoms in older palliative cancer patients: a systematic review and meta-analysis. J Pain Symptom Manage 2014; 47: 90–104.
2. Canty, 1994; Robinson et al, 2000.
3. Hoekstra et al., 2006; McMillan, 2002; McMillan & Rivera, 2009; McMillan, Tittle, Hagan & Laughlin, 2000; Tittle & McMillan, 1994.
4. Larkin PJ, Sykes NP, Centeno C. The management of constipation in palliative care: clinical practice recommendations. Palliat Med 2008; 22: 796–807.
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385997/pdf/nihms832060.pdf
6. Annals of Oncology Clinical Practice Guidelines Volume 29 | Supplement 4 | October 2018 doi:10.1093/annonc/mdy148 | iv113 reabsorption and increased sphincter tone
7. Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, et al. (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242: 212-223.
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9. . https://my.clevelandclinic.org/health/diseases/14574-fecal-bowel-incontinence
10. Pinkawa M, et al. Influence of the initial rectal distension on posterior margins in primary and postoperative radiotherapy for prostate cancer. Radiother Oncol 2006;81: 284–90. doi: 10.1016/j.radonc.2006.10.028
11. Beard CJ, et al. Analysis of prostate and seminal vesicle motion: implications for treatment planning. Int J Radiat Oncol Biol Phys 1996;34:451–8.
12. https://www.redjournal.org/article/S0360-3016(08)00223-X/fulltext