The document lists several chemotherapeutic agents that are associated with constipation, including cyclophosphamide, mechlorethamine, chlorambucil, melphalan, carmustine, lomustine, semustine, thiotepa, triethylenemelamine, busulfan, procarbazine, dacarbazine, hexamethylmelamine, cisplatin, vinblastine, vincristine, and vinorelbine.

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