Constipation and Bladder Cancer Treatment

Constipation can be fairly common during bladder cancer treatment, especially with certain chemotherapy regimens, pain medicines, and changes in diet and activity. ^[1] Some treatment plans for bladder and urothelial cancers specifically note constipation as a frequent side effect, describing stools that are less frequent, harder, smaller, and painful or difficult to pass. ^[2] Similar guidance applies when bladder cancer is treated with combination regimens, where constipation is listed among expected bowel changes. ^[3]

Why Constipation Happens

• Chemotherapy effects: Several bladder cancer chemotherapy protocols acknowledge constipation as a side effect due to slowed bowel movement and treatment‑related nausea or reduced intake. ^[1] Constipation is similarly highlighted in patient materials for newer agents used in advanced bladder cancer. ^[2]
• Pain medicines (opioids): When opioids are used for cancer‑related pain, constipation is very common and often requires proactive treatment rather than diet changes alone. [PM15] National recommendations advise preventive laxatives if opioids are taken regularly for more than a few days. ^[4]
• Reduced fluids and fiber: Illness, appetite changes, and fluid limits can lower fiber and water intake, which may contribute to harder stools. ^[5]

First-Line Self-Care Measures

• Hydration: Aim for regular fluid intake if you are not on fluid restriction; warm liquids can help trigger a bowel movement. ^[5] Drinking plenty of fluids is repeatedly recommended in bladder cancer treatment handouts. ^[1]
• Fiber: Increase fruits, vegetables, whole grains, beans, nuts, and seeds to help soften stools and improve regularity. ^[5] Eating fiber-rich foods is encouraged during bladder cancer therapy to prevent constipation. ^[2]
• Routine and movement: Try going to the bathroom at the same time daily and add gentle exercise, like walking, as tolerated. ^[6] Gentle daily activity is often advised in chemotherapy side‑effect management guides. ^[7]

When to Use Medicines

• Start a stimulant laxative: For opioid‑related constipation, experts generally suggest a stimulant laxative (such as senna) and often pair it with a stool softener to prevent hard, difficult stools. ^[8] Formal cancer guidelines support using laxatives for treatment‑related constipation, noting that non‑drug measures may be insufficient alone for opioid‑induced constipation. [PM15]
• Osmotic laxatives: Agents like polyethylene glycol can draw water into the bowel to ease passage when stools remain hard despite fiber and fluids. [PM15]
• PAMORAs for opioid‑induced constipation: If standard laxatives do not work, peripherally acting mu‑opioid receptor antagonists (PAMORAs) such as naloxegol, naldemedine, or methylnaltrexone can relieve opioid‑related constipation without reducing pain control. [PM16] These targeted medicines are effective options for opioid‑induced constipation when lifestyle and typical laxatives are inadequate. ^[9]

Practical Tips You Can Try

• Keep a bowel routine: Go 5–15 minutes after meals, especially after breakfast, to use the body’s natural reflex. ^[10]
• Don’t delay urges: Responding promptly to the urge to have a bowel movement can help maintain regularity. ^[10]
• Nutrition reminders: If appetite is low, consider smaller, more frequent meals and include high‑fiber choices plus adequate fluids to support bowel function. ^[5]
• Stay active: Even light activity can help the bowel move more regularly. ^[6]

When to Call Your Care Team

• No bowel movement for more than 3 days or persistent straining, pain, or bloating that doesn’t improve with self‑care should be discussed with your clinicians. ^[7] If constipation is not controlled, especially alongside dizziness or light‑headedness, do seek advice promptly. ^[2]
• If you are on opioids and constipation begins or worsens, ask about starting a preventive laxative plan this is usually needed with ongoing opioid use. ^[4]

Summary

Constipation is a recognized side effect during bladder cancer treatment and can stem from chemotherapy, pain medicines, and lifestyle changes. Increasing fluids and fiber, setting a bathroom routine, and gentle activity are helpful first steps. ^[5] Using stimulant and osmotic laxatives early especially with opioid pain medicines can prevent more severe constipation. ^[8] When standard measures fail, targeted medicines for opioid‑induced constipation (PAMORAs) may be considered to restore comfortable bowel movements while maintaining pain control. [PM16]