Constipation

Constipation is a common symptom in children undergoing cancer treatment or receiving palliative care. It can significantly impact comfort, appetite, and overall wellbeing, and requires proactive management.

What is constipation?

Children and young people (CYP) may produce smaller harder stools than usual, and they may go to the toilet less often.  Sometimes CYP may strain to pass stool or feel the urge but be unable to pass them. 

Constipation often produces other symptoms:

  • A bloated feeling 
  • Crampy abdominal pain 
  • Nausea and vomiting 
  • Poor appetite 
  • General tiredness 

(Khan and Khan, 2024)

What causes constipation?

Constipation in CYP with cancer may result from multiple factors: 

  • Some children may have pre-existing bowel problems prior to cancer diagnosis  
  •  Location of tumour, such as abdominal or pelvic, may compress or obstruct the bowel  
  • Reduced mobility or prolonged bedrest due to fatigue can slow bowel motility   
  • Reduction in dietary intake and fluid consumption can harden stool and slow bowel transit  
  • Some medicines such as chemotherapy (e.g. vincristine) and opioids (e.g. morphine) commonly cause constipation 

(Belsky et al., 2024)

What can help? 

Non-pharmacological 

  • Encourage fluid intake (water or fruit juice) where possible as tolerance may decline
  • Promote fibre intake if CYP is still eating (fruit, vegetables, wholemeal bread)
  • Encourage gentle physical activity such as walking

Pharmacological aids

Most children require a combination of different medications. The aim is to get a regular bowel habit, so doses should be administered consistently. 

  • Stool softeners increase fluid in the stool making them easier to pass (Lactulose/Docusate sodium) 
  • Stimulants increase the bowel contractions to move stool along the bowel (Senna/Sodium picosulfate) 
  • Suppositories may be required if oral agents are insufficient or stool becomes impacted. However, these are avoided particularly during neutropenia or thrombocytopenia because rectal trauma can increase bleeding and infection risk.  

(Gordon et al., 2016)

References

Belsky, J., Stanek, J., Yeager, N. and Runco, D. (2024). Constipation and GI diagnoses in children with solid tumours: prevalence and management. BMJ Supportive & Palliative Care, 13(e3). Available at: https://doi.org/10.1136/bmjspcare-2021-003277 (Accessed: 7 January 2026) 

Gordon, M., MacDonald, J.K., Parker, C.E., Akobeng, A.K. and Thomas, A.G. (2016). Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database of Systematic Reviews, CD009118 (8). Available at: https://doi.org/10.1002/14651858.cd009118.pub3 (Accessed: 7 January 2026). 

Khan, S.K. and Khan, M.B. (2024) Pediatric functional constipation: A new challenge. Advanced Gut & Microbiome Research, Article ID 5569563. Available at: https://doi.org/10.1155/2024/5569563 (Accessed: 7 January 2026). 

Page last updated January 2026