Sunday, September 2, 2012

Managing The Tough Times

For the past few days, Chang has been eating little and not sleeping well. Besides pain, he is also struggling with severe constipation. He has not had a bowel movement for the past 14 days.

(Before writing about this topic, I asked him if he really wants me to post about his constipation problems and he said yes, so here goes....)

Constipation is a common and frequently troublesome symptom in patients with advanced cancer. Despite its prevalence, constipation can still be an overlooked symptom, which often receives little attention until significant problems occur. Often, multiple causative factors are present:-

o Reduced food (including fibre) and fluid intake
Patients with advanced cancer often have a reduced appetite for a variety of reasons, with fibre in particular being difficult to tolerate: 
-  Some tumours produce chemical substances that suppress appetite.
- The slowdown of many bodily functions including gastric emptying, which results in early satiety and decreased hunger;
- Nausea and/or vomiting are associated with an aversion to food;
- Oral pain when attempting to eat and drink. Possible causes include oral thrush, mouth ulcers, mucositis;
- Only able to tolerate a low residue diet and are too weak to chew for any length of time

o Reduced abdominal and pelvic muscle power
Patients with advanced malignancy who are too weak to give the push necessary for defecation. 

o Reduced mobility
o Constipating drugs
(e.g. opioids, drugs with anticholinergic action, antagonist anti-emetics, iron). Opioid use is strongly associated with constipation in patients with advanced cancer. Opioids have a constipating effect whether given orally, sub-cutaneously or transdermally, although the incidence of constipation may be reduced with non-oral administration

 o The cancer itself
 If a tumour is pressing on the nerves in the spinal cord, it can slow down or stop the movement of the bowel and so cause constipation. Tumours in the abdomen can compress, squeeze, or narrow the bowel and rectum making it difficult to have a bowel motion. Or a tumour in the lining of the bowel can affect the nerve supply to the muscles and cause constipation
o Environmental factors
Environmental factors should not be overlooked. Patients unable to get to the toilet unaided may be reluctant to ask for assistance due to embarrassment or a desire not to bother their caregivers.

Treatment of Constipation
Oral measures such as laxative therapy are usually the firstline treatment of constipation. However, rectal measures such as suppositories and enemas can bring about quick results. An enema is a liquid that is squirted into the rectum and colon via the anus whereas a suppository is an easily melted pill or capsule inserted in the rectum.

In  Chang's case however, laxatives have not worked. In cases of constipation it is important not to wait if there is no bowel movement for a few days. He told me that he was too embarassed to accept help during an earlier visit to the hospital. (when a nurse asked him if he wanted an enema administered). So, during his recent stay at the hospital last week,  he asked for assistance and this time, the nurse administered the enema for him but it was unsuccessful. Back home, he has tried what he calls the "tin mining approach" ie using water to spray up the anus but has still not been successful.

The Hospis Malaysia nurse will be visiting tomorrow. Hopefully, there will be a breakthrough.

(Updated by Chang's friend)


  1. Hi,

    When my sister didn't have bowel movement for more than 5 days, we will definitely insert two suppository. This is important because she didnt have control of her bowel movement.
    Oral Laxative only soften stools to avoid impacted or hard stool. You will need to do anal suppository also to manage Chang's bowel movement. If you or any of the family member doesn't know how to, the nurse from hospice will help.
    I would really like to visit Chang. I took care of my sister in her finals months and I wish to offer some help. Please email me at

    1. Dear Emilia,

      I will inform Chang of your offer. He or his family members will contact you if help is needed. Thank you.

      Chang's Friend

  2. Chang,

    We continue to pray for you, may there be breakthrough,

    rgds, nkp

  3. Salam,

    If someone is reading this, please tell Chang that to take 1 teaspoon of black seed oil three times a day. Take it with vegetable juice.

    Hope this message gets to him.


  4. is he sleeping properly??? is he stressed to the maximum?? is he worry about his future??
    all these can cause the problem described.

    again, i wish he would try calling or crying on to his creator to remove his illness or pain. prayer is the man's best friend. our body is in complete obedience of the creator and only his help is needed to resolve things beyond our power. the one and only almighty God is 24/7 waiting your sincere call for help.

    the first weapon for this predicament is the psychology of the patient. the psychology needs to be geared to positiveness. death is be loved by all mankind but only the righteous love it. we must first think that it is a journey for us all for sure so if i am dying doesnt mean that others will not follow soon. everyone will follow.

    the next fear is what i am going to meet infront of me?? well, if we believe and do good work, then we have nothing but the welcoming of peace and bliss forever and ever.

    if i was chang, i will try to elevate my readers spiritually so that they can all feel the need for preparing themselves for the next world.

    i hope im not offending some readers here.

    all peace