1. Chemotherapeutic agents associated with
constipation
Cyclophosphamide
Mechlorethamine
Chlorambucil
Melphalan
Carmustine (BCNU)
Lomustine (CCNU)
Semustine (Methyl-CCNU)
Thiotepa
Triethylenemelamine
Busulfan
Procarbazine
Dacarbazine
Hexamethylmelamine
Cisplatin
Vinblastine
Vincristine
Vinorelbine
Source: Palliative Care Nursing- A Guide to Practice.
733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200
Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com

2. Causes of constipation in end-stage disease
General factors
• anorexia;
• decreased food intake and inadequate dietary fiber;
• dehydration (due to poor fluid intake, vomiting, sweating, or
polyuria);
• lack of activity, immobility, weakness;
• decreased abdominal muscle tone;
• Inconvenient toilet access and suboptimal posture.
• fear of incontinence;
• lack of privacy (shared accommodation);
• distress through loss of independence (reliance on others for
assistance);
• adverse past experiences (inability to access or use toilet facility;
past use of aperients
• that were too strong);
• Confusion (perhaps due to sedation).
Specific pathology
• depression;
• impaired cognitive function;
• spinal cord compression;
• cerebral tumour;
• hypercalcaemia;
• hypokalaemia;
• hypothyroidism;
• Abdominal tumour (intestinal tumour, or compression from
tumour external to bowel).
• Painful ano-rectal conditions.
Medications
• opioids, non-steroidal anti-inflammatory drugs (NSAIDs);
• antidepressants, phenothiazines, haloperidol;
• antispasmodics;
• anticonvulsants;
• antiemetics;
• diuretics;
• iron;
• Antacids.
Source: Palliative Care Nursing- A Guide to Practice.
733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200
Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com

3. Consequences of constipation
Psychological and cognitive
• distress, anxiety;
• confusion.
Perianal problems
• anal fissure;
• haemorrhoids.
Faecal impaction
• spurious diarrhoea;
• faecal incontinence.
Gastrointestinal symptoms
• anorexia, nausea, vomiting;
• abdominal distension;
• abdominal pain;
• bowel obstruction.
Urinary
• urinary retention;
• urinary tract infections.
Source: Palliative Care Nursing- A Guide to Practice.
733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200
Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com