How to Relieve Constipation in Cancer & Advanced Illness (Palliative Care Doctor Explains)

If constipation is left unchecked, it can really impair your quality of life. While common advice like "drink more water" or "eat more fiber" is well-intentioned, in the world of palliative care, it is often not enough—and can sometimes even make things worse. In Part 2 of our series, Palliative Care Physician Dr. Jonathan Wong discusses the evidence-based treatments that actually provide relief. We cover the different types of laxatives, why timing is the secret to success, and the advanced medications designed specifically for Opioid Induced Constipation (OIC). This video focuses on non-pharmacological strategies, laxative options, and a detailed discussion on opioid-induced constipation, including when and how stimulant laxatives, osmotic laxatives, and newer medications such as PAMORAs (peripherally acting mu-opioid receptor antagonists) may be used. You’ll learn how different treatments work, which options are often ineffective or poorly tolerated in palliative care, what to avoid (including fibre supplements in low-fluid states), and how bowel care goals must be individualized as illness progresses. 📌 This video covers: What “normal” bowel function means in advanced illness Non-drug approaches and their limitations in palliative care Stimulant, osmotic, and stool-softening laxatives explained Prevention and treatment of opioid-induced constipation PAMORAs: how they work and when they may be appropriate Emerging treatments on the horizon #palliativecare #palliative #opioidinducedconstipation If you haven't seen Part 1 of this series on constipation, here's a link:    • Constipation in Cancer & Serious Illness: ...   00:00 Intro 00:55 Welcome & Disclosure 01:33 Goals and what is normal? 04:01 Diet & exercise, Non-pharmacological treatments 05:21 Psyllium supplements 06:28 Other non-pharmacological treatments 06:55 Complementary therapies 07:30 Pharmacological treatments, laxatives intro 08:08 Docusate 09:05 Stimulant laxatives 10:22 Osmotic laxatives 12:40 Rectal options 14:18 Opioid induced constipation - Treatments and prevention 16:01 PAMORAs 19:10 New options 19:55 Summary About this channel: Welcome to Palliative Care Explained - a channel aimed at answering your questions about palliative care and end of life care. My name is Dr. Jonathan Wong (MD, FRCPC) and I am a palliative care doctor based out of Winnipeg, Canada. Brought online March 28, 2025, Palliative Care Explained is a channel aimed at answering your questions about palliative care. My formal medical training is in internal medicine and palliative care and I have been working in the field of palliative care since 2011. It is my hope that this channel will better inform viewers about palliative care, end of life care and living with a serious illness. Intro music written & recorded by: Jonathan Wong Committee advisors: Dr. P. Daeninck MD, MSc, FRCPC Dr. E. Giannouli MD, FRCPC Dr. J. Strutinsky-Mason MD, MSc, MRCP (UK) Disclaimer and medical-legal statements: *As a medical professional speaking to you, I hereby declare that I do not have any conflicts of interest that would compromise the integrity of the presented information. *I do not have any financial sponsors nor am I receiving any funding from the pharmaceutical industry. *This channel and its production, is my own undertaking, with support from other palliative care experts. *This video series is for educational purposes only and is intended for audiences in Canada. *The presented information may not be applicable to all viewers. *I am not providing any direct medical treatment or advice to the viewer. *These videos are not meant to imply or establish a therapeutic relationship with the viewer. *These videos are not to replace or subvert the advice from the viewer’s own doctor or health care provider team. *Any further questions should be directed to the medical team most familiar with the viewer’s unique situation. References and further reading: Palliative Medicine – A Cased Based Manual Fourth Edition MacDonald S, Herx L, Boyle A Copyright Oxford University Press 2022. Published by Oxford University Press. Oxford Textbook of Palliative Medicine Sixth Edition Cherny N, Fallon M, Kaasa S, Portenoy R, Currow D. Copyright Oxford University Press 2021. Published by Oxford University Press. JAMA Evidence Care at the close of life – Evidence and Experience McPhee S, Winker M, Rabow M, Pantilat S, Markowitz A Copyright American Medical Association 2011. Published by McGraw-Hill.