What is constipation? 

Constipation is when you have infrequent bowel movements and stool that may be hard, dry, and difficult to pass. You may also have stomach cramps, bloating, and nausea when you are constipated.

Talking with your health care team about constipation

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What problems should I call you about?
• What information should I keep track of and share with you? (For example, you may be asked to keep track of your bowel movements, meals that you have, and exercise that you do each day.)
• How much liquid should I drink each day?
• What steps can I take to feel better?
• Would you give me the name of a registered dietitian who can tell me about foods that might help?
• Should I take medicine for constipation? If so, what medicine should I take? What medicine should I avoid?

What causes constipation? 

Cancer treatments such as chemotherapy can cause constipation. Certain medicines (such as pain medicines), changes in diet, not drinking enough fluids, and being less active may also cause constipation.

Ways to prevent or treat constipation

There are steps you can take to prevent constipation. It is easier to prevent constipation than to treat its complications which may include fecal impaction or bowel obstruction. 

Take these steps to prevent or treat constipation:

Eating Hints: Before, during, and after Cancer Treatment

Learn about treatment side effects that may affect eating and what to do about them.

• Eat high-fiber foods. Adding bran to foods such as cereals or smoothies is an easy way to get more fiber in your diet. Ask your health care team how many grams of fiber you should have each day. If you have had an intestinal obstruction or intestinal surgery, you should not eat a high-fiber diet. 
• Drink plenty of liquids. Most people need to drink at least 8 cups of liquid each day. You may need more based on your treatment, medications you are taking, or other health factors. Drinking warm or hot liquids may also help.
• Try to be active every day. Ask your health care team about exercises that you can do. Most people can do light exercise, even in a bed or chair. Other people choose to walk or ride an exercise bike for 15 to 30 minutes each day.
• Learn about medicine. Use only medicines and treatments for constipation that are prescribed by your doctor, since some may lead to bleeding, infection, or other harmful side effects in people being treated for cancer. Keep a record of your bowel movements to share with your doctor or nurse.

Talking with your health care team about constipation

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What problems should I call you about?
• What information should I keep track of and share with you? (For example, you may be asked to keep track of your bowel movements, meals that you have, and exercise that you do each day.)
• How much liquid should I drink each day?
• What steps can I take to feel better?
• Would you give me the name of a registered dietitian who can tell me about foods that might help?
• Should I take medicine for constipation? If so, what medicine should I take? What medicine should I avoid?

What is delirium?

Delirium is a confused mental state that includes changes in awareness, thinking, judgment, sleeping patterns, as well as behavior. Although delirium can happen at the end of life, many episodes of delirium are caused by medicine or dehydration and are reversible.

The symptoms of delirium usually occur suddenly (within hours or days) over a short period of time and may come and go. Although delirium may be mistaken for depression or dementia, these conditions are different and have different treatments.

Different types of delirium and symptoms

The three main types of delirium include:

• Hypoactive delirium: The patient seems sleepy, tired, or depressed.
• Hyperactive delirium: The patient is restless, anxious, or suddenly agitated and uncooperative.
• Mixed delirium: The patient changes back and forth between hypoactive delirium and hyperactive delirium.

Causes of delirium

Your health care team will work to find out what is causing delirium, so that it can be treated. Causes of delirium may include:

• advanced cancer
• older age
• brain tumors
• dehydration
• infection
• taking certain medicines, such as high doses of opioids
• withdrawal from or stopping certain medicines

Early monitoring of someone with these risk factors for delirium may prevent it or allow it to be treated more quickly.

Changes caused by delirium can be upsetting for family members and dangerous to the person with cancer, especially if judgment is affected. People with delirium may be more likely to fall, unable to control their bladder and/or bowels, and more likely to become dehydrated. Their confused state may make it difficult to talk with others about their needs and make decisions about care. Family members may need to be more involved in decision-making.

Ways to treat delirium in people with cancer

Steps that can be taken to treat symptoms related to delirium include:

• Treat the causes of delirium: If medicines are causing delirium, then reducing the dose or stopping them may treat delirium. If conditions such as dehydration, poor nutrition, and infections are causing the delirium, then treating these may help.
• Control surroundings: If the symptoms of delirium are mild, it may help to keep the room quiet and well lit, with a clock or calendar and familiar possessions. Having family members around and keeping the same caregivers, as much as possible, may also help.
• Consider medicines: Medicines are sometimes given to treat the symptoms of delirium. However, these medicines have serious side effects and patients receiving them require careful observation by a doctor.
• Sometimes sedation may help: After discussion with family members, sedation is sometimes used for delirium at the end of life, if it does not get better with other treatments. The doctor will discuss the decisions involved in using sedation to treat delirium with the family.

Talking with your family member’s health care team

Prepare for the visit by making a list of questions to ask. Consider adding these questions to your list:

• Is my family member at risk for delirium?
• What is causing the delirium?
• What problems should we call you about?
• What treatments are advised for my family member?

What is diarrhea?

Diarrhea means having bowel movements that are soft, loose, or watery more often than normal. If diarrhea is severe or lasts a long time, the body does not absorb enough water and nutrients. This can cause you to become dehydrated or malnourished.

What causes diarrhea?

Cancer treatments, or the cancer itself, may cause diarrhea or make it worse. Some medicines, infections, and stress can also cause diarrhea. Tell your health care team if you have diarrhea.

What are the dangers of diarrhea?

Diarrhea that leads to dehydration (the loss of too much fluid from the body) and low levels of salt and potassium (important minerals needed by the body) can be life threatening. Call your health care team if you feel dizzy or lightheaded, have dark yellow urine or are not urinating, or have a fever of 100.5 °F (38 °C) or higher.

Ways to manage diarrhea

You may be advised to take steps to prevent complications from diarrhea:

Eating Hints: Before, during, and after Cancer Treatment

Learn about treatment side effects that may affect eating and what to do about them.

• Drink plenty of fluid each day. Most people need to drink 8 to 12 cups of fluid each day. Ask your doctor or nurse how much fluid you should drink each day. For severe diarrhea, only clear liquids or IV (intravenous) fluids may be advised for a short period.
• Eat small meals that are easy on your stomach. Eat six to eight small meals throughout the day, instead of three large meals. Foods high in potassium and sodium (minerals you lose when you have diarrhea) are good food choices, for most people. Limit or avoid foods and drinks that can make your diarrhea worse.
• Check before taking medicine. Check with your doctor or nurse before taking medicine for diarrhea. Your doctor will prescribe the correct medicine for you.
• Keep your anal area clean and dry. Try using warm water and wipes to stay clean. It may help to take warm, shallow baths. These are called sitz baths.

Questions to ask your health care team about diarrhea

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What is causing the diarrhea?
• What symptoms should I call you about?
• How much liquid should I drink each day?
• Can I speak to a registered dietitian to learn more about foods and drinks that are best for me?
• What medicine or other steps can I take to prevent diarrhea and to decrease rectal pain?

Listen to tips on how to manage diarrhea caused by your cancer treatments such as radiation therapy.
(Type: MP3 | Time: 2:55 | Size: 2.7MB)
View Transcript

What is edema?

Edema is swelling caused by a buildup of fluid that gets trapped in your body’s tissues. Edema may also be called fluid retention. While edema is most common in your legs, ankles, and feet, it can occur anywhere in your body. 

Tell your doctor or nurse if you notice swelling so they can assess your symptoms and talk with you about ways to lower swelling.

Types of edema

This page focuses on peripheral edema, which is the buildup of fluid in your extremities, such as your legs, feet, or ankles, or in your arms or hands. Edema that happens in your lower legs or feet may be called pedal edema. 

Other types of edema occur in different parts of the body:

• Ascites: Fluid builds up in the abdomen. Learn more about Ascites and Cancer.
• Cerebral edema: Fluid builds up in the brain.
• Macular edema: Fluid builds up in a part of the eye called the macula.
• Pericardial effusion: Fluid builds up between the heart and the pericardium (the sac around the heart). Learn more about malignant pericardial effusion at Cardiopulmonary Syndromes. 
• Pleural effusion: Fluid builds up around the lungs in a space called the pleural cavity. Learn more about malignant pleural effusion at Cardiopulmonary Syndromes. 
• Pulmonary edema: Fluid builds up in the lungs.
• Scrotal edema: Fluid builds up in the scrotum (sac around the testicles).

What causes peripheral edema?

Peripheral edema may be caused by cancer, cancer treatments, or medicines you are taking. Peripheral edema can also be caused by health conditions that are not related to cancer.

Peripheral edema caused by cancer

Peripheral edema may be a sign or symptom of some types of cancer. For instance, cancers located near the pelvic veins, such as kidney cancer, liver cancer, ovarian cancer, and uterine cancer are most likely to cause edema in your leg or foot. 

Peripheral edema caused by cancer treatments

Chemotherapy may cause a buildup of fluid in the extremities, as can some types of hormone therapy, immunotherapy, and targeted therapy. Swelling caused by cancer treatment is generally mild and usually goes away after treatment ends.

Other causes of peripheral edema

• Medicines. Some medicines, such as blood pressure medicine, corticosteroids, birth control pills, and NSAIDs (e.g., ibuprofen) can cause your body to hold on to salt and water, leading to swelling in your arms, legs, and feet. In rare cases, swelling may be caused by a severe allergic reaction to a medicine. 
• Medical conditions. Congestive heart failure, chronic kidney disease, liver disease (cirrhosis), lung conditions, and thyroid conditions may cause edema. 
• Deep vein thrombosis (DVT). When a blood clot forms in a deep vein, such as those in the leg, it can cause edema. 
• Pregnancy. Edema is common during pregnancy. 
• Lifestyle and dietary factors. Being less active and more sedentary, as well as a diet high in sodium (salt) can also cause edema. Salt makes your body hold onto fluid. Not eating enough protein can also lead to edema.

Signs and symptoms of peripheral edema

• heaviness and swelling in one or both legs or arms 
• swollen ankles, feet, or hands
• skin changes, such as skin that is puffy, shiny, or slightly dented after being pressed

Tell your doctor about swelling that doesn’t go away. Early diagnosis and treatment of edema can prevent it from getting worse. Your doctor will determine the cause and talk with you about ways to lower the swelling.

Peripheral edema or lymphedema?

Both peripheral edema and lymphedema cause swelling, often in the arm or leg. But peripheral edema and lymphedema differ in important ways. Peripheral edema can have many causes, whereas lymphedema usually occurs after surgery to remove lymph nodes. Lymphedema and peripheral edema are also treated in different ways. Learn more about Lymphedema. 

Is peripheral edema life-threatening?

Peripheral edema caused by cancer and cancer treatment is usually mild. But severe swelling can be the sign of a more serious health condition and may become life-threatening.

Seek emergency medical care if you have: 

• shortness of breath
• sudden pain with swelling 
• swelling that is moving up your arms or legs
• a swollen area that becomes painful and warm to touch
• rapid weight gain
• the inability to empty your bladder

How is peripheral edema diagnosed?

Your doctor will usually diagnose peripheral edema during a physical exam. If more tests are needed, based on your symptoms, your doctor may order blood tests and imaging tests such as an ultrasound to examine the swollen area. 

Grading the severity of peripheral edema

The severity (or grade) of peripheral edema is assessed using a pitting edema scale. Your doctor will gently press on the swollen area to see if a pit or depression forms in the skin. Normally, no pit is seen when pressure is applied. 

If a pit or dimple forms after the skin is pressed, this is called pitting edema. Your doctor or nurse will record the depression and the time it takes for the pressed area to return to normal and diagnose the edema as grade 1, 2, 3, or 4, with grade 4 being the most severe. The grade of the edema is based on how deep the pit is when pressure is applied and how long it takes for the area to rebound or return to normal. 

Treatment and management of peripheral edema

Treatment for peripheral edema is based on what is causing your symptoms and their severity. Your doctor or nurse may talk with you about these and other ways to lower swelling:

• Compression stockings or sleeves. There are compression garments that can help move fluid around in your arms and legs to keep it from building up. They also help improve blood flow. Your nurse can help you find compression garments that fit properly and will show you how to use them.
• Avoid wearing tight-fitted clothing, shoes, and jewelry. These can make swelling worse.
• Raise your feet. Standing or sitting in one place for a long time can cause or worsen swelling in your legs and feet. Raising your feet with pillows or a footstool when you sit or lie down can help to prevent fluid from building up in your feet. Sitting with uncrossed legs can also help. 
• Take short walks and exercise. Walking and other light exercises can improve circulation and help to move fluid around in your body. Ask your nurse about an exercise program that is right for you.
• Diet. You may be advised to avoid foods high in sodium (salt) such as chips, bacon, ham, and canned soup. Talk with your nurse to get a list of foods and drinks to avoid.
• Diuretics (water pills). Medicines called diuretics may be prescribed to help your body get rid of fluid. These medicines cause the kidneys to make more urine, but they also come with some side effects that your doctor will discuss with you. Two diuretics used to treat edema are hydrochlorothiazide and furosemide. 
• Physical therapy or occupational therapy. A physical therapist can help you learn about exercises to help reduce swelling. An occupational therapist can help you manage activities related to daily living.

Talking with your doctor about peripheral edema

Tell your doctor or nurse as soon as you notice swelling or other symptoms of peripheral edema. Here are questions you may want to ask:

• Is the cancer I have or the treatment I’m receiving likely to cause edema?
• Are any of the medicines I’m taking likely to cause edema?
• What serious symptoms should I call you about?
• What treatments do you recommend based on my symptoms?
• Would compression socks or sleeves help? Which ones do you recommend? When and how often should I wear them?
• What foods or drinks should I avoid?
• What exercise or physical therapy do you recommend?

Getting support if you have peripheral edema

Side effects of cancer treatment, such as peripheral edema, can be hard to deal with, both physically and emotionally. It’s important to ask for support from your health care team. They can help you prepare for and make it through difficult times. Learn more about ways to cope with cancer, including ways to adjust to daily life during cancer treatment.

For family members and friends who are caring for someone with cancer, you may find these suggestions for caregivers to be helpful.

Peripheral edema research and clinical trials

Doctors and researchers are working to discover new and better ways to prevent, diagnose, and treat side effects such as peripheral edema. Your doctor may have information about open clinical trials at the hospital where you are receiving treatment or a nearby clinic.

What is anemia?

Anemia is a condition in which the number of red blood cells is below normal. 

What are signs of anemia?

Anemia can make you feel very tired, short of breath, and lightheaded. Signs of anemia may also include feeling dizzy or faint, headaches, a fast heartbeat, and/or pale skin.

What causes anemia in people with cancer?

Cancer treatments, such as chemotherapy and radiation therapy, as well as cancers that affect the bone marrow, can cause anemia. When you are anemic, your body does not have enough red blood cells. Red blood cells are the cells that that carry oxygen from the lungs throughout your body to help it work properly.

You will have blood tests to check for anemia. Treatment for anemia is also based on your symptoms and on what is causing the anemia.

Ways to manage anemia

Here are some steps you can take if you have fatigue caused by anemia:

• Save your energy and ask for help. Choose the most important things to do each day. When people offer to help, let them do so. They can take you to the doctor, make meals, or do other things you are too tired to do.
• Balance rest with activity. Take short naps during the day, but keep in mind that too much bed rest can make you feel weak. You may feel better if you take short walks or exercise a little every day.
• Eat and drink well. Talk with your doctor, nurse, or a registered dietitian to learn what foods and drinks are best for you. You may need to eat foods that are high in protein or iron.

Questions to ask your health care team about anemia

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What is causing the anemia?
• What problems should I call you about?
• What steps can I take to feel better?
• Would medicine, iron pills, a blood transfusion, or other treatments help me?
• Would you give me the name of a registered dietitian who could also give me advice?

Listen to tips on how to manage fatigue from cancer treatments such as radiation therapy.
(Type: MP3 | Time: 2:50 | Size: 2.7MB)
View Transcript