Abstract
A LTERATION in bowel function is one of the most distressing symptoms of cancer and its treatment in terms of self-esteem, daily living, and social acceptance. Changes in elimination patterns associated with cancer can result from a variety of factors, including nutritional intake, physical mobility, neurologic and metabolic functioning, surgery, direct tumor involvement, psychosocial factors, and medication. This article reviews the causes of cancer-related bowel alterations and discusses interventions and areas for future research. The process of defecation is a complex combination of mechanical stimulation, muscle contraction, and timed innervation that leads to an urge to empty the bowel. The process has been described from functional and neurologic points of view.l3 In brief, the intestinal tract digests and absorbs nutrients and fluids and excretes waste matter. Eight to ten liters of liquid from ingested fluids, food, and enzymes produced by the body travel through the digestive system each day. All but 100 mL of fluid is reabsorbed, primarily in the ascending and transverse portion of the large intestine, leaving a soft waste residue. 2.4,5 Waste is assisted through the gastrointestinal tract by peristaltic waves until the rectal vault is reached. As storage reaches its capacity, messages are sent to the brain to signal the urge to defecate, and a process begins which empties the bowel. Under normal circumstances, the number of stools ranges from 3/d to 3/wk. !,4,6 When disruption occurs at any point in the process, diarrhea or constipation may result. Assessment of bowel function should consider the following factors: the individuals' emotional, physiologic, and cultural milieu; any change in frequency, size, and consistency of stool; ease of passage; indications of excessive straining; sensations of incomplete emptying; abdominal distension, cramps or discomfort; and the appearance of stool and bowel sounds. Following assessment, a diagnosis of the alteration can be made. The common types of alteration, constipation and diarrhea, will be the focus of this paper.
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