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Blood & Cancer

71 EpisodesProduced by MDedge Hematology OncologyWebsite

Interview-style hematology/oncology podcast from MDedge Hematology-Oncology. The show is hosted by Dr. David Henry with Pearls from Dr. Ilana Yurkiewicz for clinical hematology and oncology health care professionals. The information in this podcast is provided for informational and educational purpo… read more


Ask about constipation, calling patients in the middle of the night

James C. Reynolds, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to discuss the ins and outs of constipation among cancer patients: how to recognize it, how to treat it, and why you need to ask about it.

Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University talks about those tough phone calls.

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Show notes

By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia 

  • Stool dysmotility is defined by a both objective imaging and the Bristol stool scale.
  • Narcotics, mechanical issues (anastomoses), nausea, lack of exercise, and low-liquid or low-fiber diet contribute to constipation.
  • There is a placebo effect of up to 40% for drugs given for constipation.
  • Reglan (metoclopramide) in low doses, used sporadically, is relatively safe.
    • However, it has been associated with Parkinsonian-type movement disorders and depression.
  • Gastric emptying tests (and stomach function) are influenced by stress, mood, nausea, side effects, and hormones.
    • They are not efficacious to evaluate gastric motility in the inpatient setting.
  • Anal pain and fecal incontinence can occur during acute therapy (including radiation proctitis).
    • It is important for clinicians to ask patients about constipation as it may be paradoxical and manifest as diarrhea.
  • Fecal incontinence and sphincter dysfunction following therapy is multifactorial.
    • Flat plate, proctosigmoidoscopy, and anal manometry can give a detailed description of anal function and compliance.
  • It is important for clinicians to ask patients about constipation and fecal incontinence.

Further reading:

Managing constipation in adults with cancer (J Adv Pract Oncol. 2017 Mar;8[2]:149-61).

Bristol Stool Chart


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