Symptoms Spotlight: Constipation with Abigail Johnston and Melanie Sisk

Live from Stage 4 | Episode # 016| 2/24/2026 | Symptoms Spotlight

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Hosts

Abigail Johnston lives in Orlando, Florida and has been an attorney since 2002. In 2017, while tandem breastfeeding her boys (then 1 and 3), Abigail was diagnosed with de novo Stage IV Metastatic Breast Cancer (MBC) and soon thereafter discovered that she has a genetic mutation that predisposed her to developing cancer at ATM.  Since her diagnosis, Abigail has focused her efforts on patient advocacy and supporting those people in the MBC Community through her experience and training, virtually and in person. She currently serves as the Director of Mentorship, Legal Clinics and financial services at Project Life, a founding member of the PIK3CA Pathbreakers, and volunteers with a variety of organizations including the MBC Alliance, FORCE, METAvivor, and many others.  Connect with Abigail via her blog at NoHalfMeasures.blog.

Melanie Sisk was a wife, mom of two young boys, and working full-time as a Registered Nurse when she was diagnosed with Stage 1A Breast Cancer at the age of forty-three. She completed her recommended surgery and radiation and was on endocrine therapy. Melanie thought she had put cancer behind her because she did everything right. However, she was diagnosed with Metastatic Breast Cancer at the age of forty-seven. Due to her metastatic treatment protocol and disease, she retired from her nursing career. Melanie has dived into advocacy work with an urgency to do what she can, while she can. She helped to start and moderate a local support group in her area of North Carolina called Piedmont Triad METsters. She is a trained volunteer with Cancer Services, Inc. and a Peer to Peer Support Group Leader and Light Up MBC State Captain for METAvivor. She is a Living Beyond Breast Cancer 2023 Hear My Voice MBC leadership alumna and a mentor with Project Life. She also serves on the MBC Leadership Committee for Surviving Breast Cancer. She is also a part of the new initiative, PIK3CA Pathbreakers.

Summary

In this candid conversation, Melanie Sisk and Abigail Johnston tackle a topic many cancer patients experience but few feel comfortable discussing—constipation. From understanding what constipation really looks like (hint: it's not always what you think) to practical remedies you can try at home, this episode breaks down the stigma around bowel health.

Melanie, a nurse and cancer patient on CDK4/6 inhibitors, shares her go-to over-the-counter solutions like MiraLax and Colace, plus an often-overlooked remedy: movement. Abigail introduces the "prune juice slider"—a surprisingly effective trick shared by her chemo nurse—and opens up about the challenge of swinging between constipation and diarrhea.

Whether you're dealing with medication side effects, reduced mobility, or just trying to understand your symptoms better, this episode offers honest, practical advice. Learn when to troubleshoot on your own, when to reach out to your care team, and why talking to a GI specialist might be the missing piece of your symptom management puzzle.

Key Topics:

• Recognizing the signs of constipation beyond straining

• Over-the-counter remedies and natural solutions

• The role of movement in digestive health

• Avoiding the pendulum swing between constipation and diarrhea

• When to seek help from your medical team

Key Takeaways

1. Constipation isn't always obvious. It can present as small pellet-like stools, bloating, or feeling heavy, not just straining on the toilet.

2. Movement is medicine. Walking and physical activity promote peristalsis (the natural movement of stool through your intestines), especially important if you've been sedentary due to pain or fatigue.

3. Start with simple OTC remedies: MiraLax (stool softener), Colace, and milk of magnesia are accessible first-line options available at any drugstore.

4. Try the "prune juice slider.” Warm prune juice in a shot glass topped with melted real butter can be surprisingly effective.

5. Multiple factors contribute to constipation. Medications (like CDK4/6 inhibitors), diet, and reduced mobility can all play a role.

6. Don't be embarrassed to talk about it. Bowel movements are a normal part of life. Discuss symptoms openly with your oncology team, pharmacist, or dietician.

7. Beware of overcorrecting. Swinging between constipation and diarrhea can happen if you overmedicate. A GI specialist can help you calibrate the right approach for your body.

8. Troubleshoot first, then ask for help. Try simple interventions on your own, but don't hesitate to reach out to your medical team when needed.

• Transcript

  [00:01:29] Melanie Sisk: Hello Abigail. We have an interesting topic today. I don't know if anyone heard our other talk about diarrhea, but today we're on the other end of the spectrum, which is constipation. How many times as a cancer patient have you dealt with constipation?

  [00:01:48] Abigail Johnston: So. Constipation doesn't show up for me as much as diarrhea.

  I have a feeling that that kind of pattern might have been established in my body from before cancer. But I've dealt with it a little. I think you've dealt with it maybe more than I have, Melanie.

  [00:02:06] Melanie Sisk: I have dealt with constipation, and sometimes I think you don't even realize you're constipated until you go to the toilet and it's a bunch of little balls that come out.

  And that is constipation because you shouldn't have a bunch of little balls and even to have the texture of a long movement, but it's a bunch of balls together, that's still constipation. And I think some people really don't even realize that. But you can have different symptoms of constipation.

  You can have bloating, you just feel heavy. You don't know what's wrong. So it can present in several different ways. But I think most people think it's when you're on the toilet and you're straining and you're having trouble getting it to move out. So I am on a CDK4/6 inhibitor.

  I just use a lot of the over the counter medications for it. Even just simple, something as simple as MiraLax, which is like a stool softener that kind of softens it up a little bit, but not, it's not like a

  laxative, right? Because you have different forms. So for me, I tend to try things like that when it gets a little bit worse. I might throw in some Colace in there. These are all over the counter things that you can buy at your drugstore. And if it gets really bad, you can always do milk or magnesium.

  But one thing I think people don't really think about is movement, getting up and moving your body. So when you walk, when you're moving around, that's your body's way of peristalsis, which is actually moving the poop through your intestines. There's probably a better word than poop, but anyway, so that's your body's normal way.

  So if you think about it, if you've been in a lot of pain and you've been more sedentary, that can actually lead to more constipation. So it could be the medications, it could be your diet, it could be how you're moving or not moving every day.

  [00:04:04] Abigail Johnston: Well, now I'm sitting here thinking that maybe I actually have more than I realized because maybe I didn't quite understand what the definition is, and that's really helpful to understand what it is, to be able to name it correctly. I really liked how you explained that, Melanie, one of the chemo nurses when I first got diagnosed and was taking Adriamycin and Cytoxin, she shared with me a remedy that she called a prune juice slider.

  So you get some prune juice and you make it nice and warm and you put it in a shot glass and you take a slab of butter. Real butter. Nice and melty. Stick it on top of that prune juice, and then you just toss it back. And that has been incredibly effective for me. Anytime I've gotten to the point where I felt like I needed something to get everything moving, but

  now I'm thinking that perhaps some of the times where I've been extremely fatigued that that sedentariness, this actually ended up causing a little bit more of the bowel movement issues that I was experiencing, and I'm really glad you mentioned movement, Melanie, because we can ask for interventions from our teams, and sometimes we need those interventions, but doing a little troubleshooting on our own can actually really mean that by the time we get to

  asking for help, we have tried a few things and I think sometimes that's good.

  [00:05:34] Melanie Sisk: Exactly, and I think people don't even realize that they're constipated, like I said earlier, because they don't know what it is. So just knowing what it is. Even on the milder cases that, hey, you're starting to get a little bit constipated.

  What should we do about it? Here you have to excuse my frankness. I'm a nurse, so I just talk about it like it is, you know? But, um, I

  [00:05:57] Abigail Johnston: appreciate that, Melanie. 'cause it's clear when you're using language that everybody understands, and I got two boys. Uh, we tend to talk about bodily movements probably in a different way or in my household.

  [00:06:09] Melanie Sisk: Hey, I have two boys as well too, so I know all about that. Mine are 21 and 19 and it never changes. Never. So, but yeah, I think definitely talking to your doctor. Even your pharmacist or your dietician, whoever you have on your team, talking about the problems that you're having, I think is great because they can help you with some interventions that you may not have even thought about or may never even tried.

  And a lot of those are over the counter things that we can get ourselves. So, yeah, and I think sometimes it's embarrassing for people to talk about their bowel movements or the lack of with their doctor. But the thing is, everybody has 'em every day. It's a normal part of life, so it shouldn't be a taboo subject for sure, especially not with cancer patients.

  We talk about everything.

  [00:07:02] Abigail Johnston: We need to talk about everything. I just wanna throw in one other thing that has made some of this complicated for me and that is, Melanie, shifting between diarrhea and constipation. While I've had the extreme swinging between diarrhea and constipation, where I actually found out after working with my GI doctor that I was overmedicating myself.

  And some of the things I was overmedicating myself with were things like, you mentioned with MiraLax, Colace, milk of magnesia, because I don't always experience constipation as much. I didn't know how to calibrate how much to take, and so I ended up having the pendulum swinging back and forth, and

  I couldn't get it leveled out, which was making my life a whole lot more complicated. So I did just want to make the suggestion that if you're having trouble troubleshooting or having trouble getting to someone on your medical oncology team, don't forget that a GI doctor might be able to help you calibrate what you're doing in a way that matches your body.

  [00:08:12] Melanie Sisk: That is some really great advice. Definitely seek out the help wherever you can find it.