Supportive Care in Cancer

, Volume 24, Issue 2, pp 691–698 | Cite as

Constipation in specialized palliative care: factors related to constipation when applying different definitions

  • E. Erichsén
  • A. Milberg
  • T. Jaarsma
  • M. Friedrichsen
Original Article



For patients in palliative care, constipation is primarily a result of opioid treatment. Impacts from other factors related to constipation in palliative care are rarely studied.


The aim was to identify factors related to constipation in patients in palliative care, and then to compare these factors between patients with different types of constipation and patients without constipation.


Cross-sectional data on constipation was collected with a 26-item questionnaire from 485 patients in 38 specialist palliative care units in Sweden. Three different constipation groups were used; MC ONLY, PC ONLY, and MC & PC. Logistic regression analyses were used to calculate odds ratios.


Patients with <3 defecations/week, MC ONLY, (n = 36) had higher odds of being hospitalized, bed-restricted, in need of personal assistance for toilet visits, and of having a poor fluid intake. Patients with the perception of being constipated, PC ONLY, (n = 93) had higher odds of having poor appetite, hemorrhoids, hard stool, more opioid treatment, less laxative treatment and of being more dissatisfied with constipation information. Patients with both <3 defecations/week and a perception of being constipated, MC & PC, (n = 78) had higher odds of having cancer- disease.


There were several significant factors related to constipation with higher odds than opioid- treatment, for patients in palliative care, such as; hard stool, cancer diagnosis, dissatisfaction with information, low fluid intake, hemorrhoids, bed restriction, hospitalization, and need of personal assistance for toilet visits.


Palliative care Constipation Risk factors Symptom assessment 



This study was supported by grants from the Medical Research Council of Southeast Sweden (FORSS) and Vrinnevi Hospital Research Board.


The authors declare no conflict of interest.


  1. 1.
    Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R (2009) The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European patient survey (probe 1). Pain Med 10:35–42PubMedCrossRefGoogle Scholar
  2. 2.
    Friedrichsen M, Erichsen E (2004) The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs 10:321–325PubMedCrossRefGoogle Scholar
  3. 3.
    Clark K, Currow DC (2013) Constipation in palliative care: what do we use as definitions and outcome measures? J Pain Symptom Manag 45:753–762CrossRefGoogle Scholar
  4. 4.
    Clark K, Lam L, Currow DC, Agar M (2014) A prospective study to investigate contributory factors that lead to constipation in palliative care patients. J Pain Symptom Manag. doi: 10.1016/j.jpainsymman.2014.01.005 Google Scholar
  5. 5.
    Bader S, Jaroslawski K, Blum HE, Becker G (2011) Opioid-induced constipation in advanced illness: safety and efficacy of methylnaltrexone bromide: 201–211Google Scholar
  6. 6.
    Bookbinder M, McHugh ME (2010) Symptom management in palliative care and end of life care. Nurs Clin N Am 45:271–327CrossRefGoogle Scholar
  7. 7.
    Johnson MJ, Houghton T (2006) Palliative care for patients with heart failure: description of a service. Palliat Med 20:211–214PubMedCrossRefGoogle Scholar
  8. 8.
    Clark K, Urban K, Currow DC (2010) Current approaches to diagnosing and managing constipation in advanced cancer and palliative care. J Palliat Med 13:473–476PubMedCrossRefGoogle Scholar
  9. 9.
    Zhou L, Lin Z, Lin L, Wang M, Zhang H (2010) Functional constipation: implications for nursing interventions. J Clin Nurs 19:1838PubMedCrossRefGoogle Scholar
  10. 10.
    Lamy O, Jenzer-Closuit A, Burckhardt P (2001) Hypercalcaemia of malignancy: an undiagnosed and undertreated disease. J Intern Med 250:73–79PubMedCrossRefGoogle Scholar
  11. 11.
    Hjalte F, Berggren A-C, Bergendahl H, Hjortsberg C (2010) The direct and indirect costs of opioid-induced constipation. J Pain Symptom Manag 40:696–703CrossRefGoogle Scholar
  12. 12.
    Bosshard W, Dreher R, Schnegg J, Büla CJ (2004) The treatment of chronic constipation in elderly people: an update. Drugs Aging 21:911–930PubMedCrossRefGoogle Scholar
  13. 13.
    Clark K, Smith JM, Currow DC (2012) The prevalence of bowel problems reported in a palliative care population. J Pain Symptom Manag 43:993-1000493–993-1000499Google Scholar
  14. 14.
    Garrigues V, Galvez C, Ortiz V, Ponce M, Nos P, Ponce J (2004) Prevalence of constipation: agreement among several criteria and evaluation of the diagnostic accuracy of qualifying symptoms and self-reported definition in a population-based survey in Spain. Am J Epidemiol 159:520–526PubMedCrossRefGoogle Scholar
  15. 15.
    Yea T (2013) Randomized, double-blind. Placebo-controlled trial of oral docusate in the management of constipation in hospice patients. J Pain Symptom Manag 45:2–13CrossRefGoogle Scholar
  16. 16.
    Iovino P, Chiarioni G, Bilancio G, Cirillo M, Mekjavic IB, Pisot R, Ciacci C (2013) New onset of constipation during long-term physical inactivity: a proof-of- concept study on the immobility-induced bowel changes. PLoS ONE 8(8):e72608 doi:10.1371PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Richmond JP, Wright ME (2008) Establishing reliability and validity of a constipation risk assessment scale. J Orthop Nurs 12:139–150CrossRefGoogle Scholar
  18. 18.
    Lewis SJ, Heaton KW (1997) Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32:920–924PubMedCrossRefGoogle Scholar
  19. 19.
    Garner S (2013) Prescribing for the elderly. Pract Nurs 43:19–25Google Scholar
  20. 20.
    Herz MJ, Kahan E, Zalevski S, Aframian R, Kuznitz D, Reichman S (1996) Constipation: a different entity for patients and doctors. Fam Pract 13:156–159PubMedCrossRefGoogle Scholar
  21. 21.
    Goodman M, Low J, Wilkinson S (2005) Constipation management in palliative care: a survey of practices in the United Kingdom. J Pain Symptom Manag 29:238–244CrossRefGoogle Scholar
  22. 22.
    Dhingra L, Shuk E, Grossman B, Strada A, Wald E, Portenoy A, Knotkova H, Portenoy R (2013) A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease. Palliat Med 27:447–456PubMedCrossRefGoogle Scholar
  23. 23.
    Rhondali W, Nguyen L, Lynn Palmer J, Kang D-H, Hui D, Bruera E (2013) Self-reported constipation in patients with advanced cancer: a preliminary report. J Pain Symptom Manag 45:23–32CrossRefGoogle Scholar
  24. 24.
    McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 61:50–62PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Cash B, Mitchner NA, Ravyn D (2011) Confidence-based learning CME: overcoming barriers in irritable bowel syndrome with constipation. J Contin Educ Heal Prof 31:157–164CrossRefGoogle Scholar
  26. 26.
    Hoekstra J, de Vos R, van Duijn NP, Schadé E, Bindels PJ (2006) Using the symptom monitor in a randomized controlled trial: the effect on symptom prevalence and severity. J Pain Symptom Manag 31:22–30CrossRefGoogle Scholar
  27. 27.
    Erichsen E, Milberg A, Jaarsma T, Friedrichsen M (2015) Constipation in specialized palliative care: prevalence, definition, and patient-perceived symptom distress. J Palliat Med. doi: 10.1089/jpm.2014.0414 PubMedGoogle Scholar
  28. 28.
    Longstreth GF, Grant Thompson W, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Introduction: functional bowel disorders. Gastroenterology 130:1480–1491PubMedCrossRefGoogle Scholar
  29. 29.
    Portenoy RK, McCarthy Lepore J, Kiyasu E, Sobel K, Coyle N, Thaler HT, Friedlander-Klar H, Kornblith AB, Kemeny N, Norton L, Scher H (1994) The memorial symptom assessment scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30:1326–1336CrossRefGoogle Scholar
  30. 30.
    Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72PubMedCrossRefGoogle Scholar
  31. 31.
    Groenvold M, Petersen MA, Aaronson NK, Arraras JI, Blazeby JM, Bottomley A, Fayers PM, de Graeff A, Hammerlid E, Kaasa S, Sprangers M, Bjorner JB, Lo C, Burman D, Swami N, Gagliese L, Rodin G, Zimmermann C, Fex A, Flensner G, Ek AC, Soderhamn O (2012) The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. Eur J Cancer 42:55–64CrossRefGoogle Scholar
  32. 32.
    Vellas B, Villars H, Abellani G, Soto MI, Rolland Y, Guigos Y, Morley JE, Chumlea W, Salva A, Ruebenstein LZ (2006) Overview of the MNA (R) -its history and challenges. J Nutr Health Aging 10:456–463PubMedGoogle Scholar
  33. 33.
    Kyle G (2007) Continence journal. Norgine risk assessment tool for constipation. Nurs Times 103:48–49Google Scholar
  34. 34.
    Dinning PG, Hunt L, Lubowski DZ, Kalantar JS, Cook IJ, Jones MP (2011) The impact of laxative use upon symptoms in patients with proven slow transit constipation. BMC Gastroenterol. doi: 10.1186/1471-230x-11-121 PubMedPubMedCentralGoogle Scholar
  35. 35.
    Ahmedzai SH, Boland J (2010) Constipation in people prescribed opioids. Clin Evid (Online) 2010Google Scholar
  36. 36.
    Clemens KE, Klaschik E (2008) Management of constipation in palliative care patients. Curr Opin Support Palliat Care 2:22–27PubMedCrossRefGoogle Scholar
  37. 37.
    Solheim TS, Blum D, Fayers PM, Hjermstad MJ, Stene GB, Strasser F, Kaasa S (2014) Weight loss, appetite loss and food intake in cancer patients with cancer cachexia: three peas in a pod? -analysis from a multicenter cross sectional study. Acta Oncol 53:539–546PubMedCrossRefGoogle Scholar
  38. 38.
    Noiesen E, Trosborg I, Bager L, Herning M, Lyngby C, Konradsen H (2013) Constipation - prevalence and incidence among medical patients acutely admitted to hospital with a medical condition. J Clin Nurs 23:2295–2302PubMedCrossRefGoogle Scholar
  39. 39.
    Sacomori C, Silveira C, Sperandio FF, Cardoso FL Prevalence, repercussion and factors associated with intestinal constipation in women in Florianópolis. J Coloproctol doi:  10.1016/j.jcol.2014.08.006
  40. 40.
    Holmes S (2011) Importance of nutrition in palliative care of patients with chronic disease. Nurs Stand 25:48–56CrossRefGoogle Scholar
  41. 41.
    Larkin PJ, Sykes NP, Centeno C, Ellershaw JE, Elsner F, Eugene B, Gootjes JR, Nabal M, Noguera A, Ripamonti C, Zucco F, Zuurmond WW, European Consensus Group on Constipation in Palliative Care (2008) The management of constipation in palliative care: clinical practice recommendations. Palliat Med 22:796–807PubMedCrossRefGoogle Scholar
  42. 42.
    Hawley P, Barwich D, Kirk L (2011) Implementation of the Victoria bowel performance scale. J Pain Symptom Manag 42:946–953CrossRefGoogle Scholar
  43. 43.
    Year report of the Swedish register of palliative care 2012. Accessed October 23 2014.

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Social and Welfare StudiesLinköping UniversityNorrköpingSweden
  2. 2.Department of Advanced Home Care and Department of Social and Welfare StudiesLinköping UniversityNorrköpingSweden
  3. 3.Palliative Education and Research Centre and Department of Social and Welfare StudiesLinköping UniversityNorrköpingSweden

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