Constipation is a common problem for cancer patients. Pain medications, certain chemotherapy drugs, poor food and drink intake, and decreased activity all can contribute to the development of this condition. Constipation is present when there is difficulty passing a stool. While a person may normally have one stool a day, another person may move his bowels every other or even third day; as long as the person does not have difficulty passing the stool, he is not constipated. Remember prevention is preferable to treatment of constipation.

It is important to get enough bulk in the diet to stimulate the bowels, and enough fluids to keep the stool soft. You should drink at least 6-8 eight ounce glasses of fluids a day and try to eat bulk-containing foods such as fruits, vegetables, and grains. Limit your intake to foods which can contribute to hard stools, such as cheeses, meats and rice. (If you have special dietary needs, a consultation with the registered dietitian might benefit you. Your nurse can arrange for such a meeting.)

Exercise helps stimulate digestion and prevent constipation. Simple walking is an activity most patients tolerate well. Just being out of bed as tolerated is helpful. Responding to the urge to have a bowel movement is important, in order to develop a pattern natural to you.

• Drink 6-8 eight ounce glasses of fluids daily
• Eat bulk-producing foods and limit binding foods
• Maintain activity as much as possible
• Develop a pattern of elimination
• If constipation occurs, or for patients with regular doses of narcotics, the laxative protocol is initiated
  

A daily bowel regimen should be followed just as carefully as your doctor's other instructions. The overall goal is to have a bowel movement approximately every 2-3 days. Because responses vary, use the guidelines below to find a regimen that works best for you. If at any time the dosage of your pain-relieving medication is changed, you may also need to increase or decrease your daily dosage of laxative. See your doctor or nurse for a change in dose.

Step 1: Take 2 Senokot-S tablets at bedtime.

If you do not have a bowel movement in the morning,

Step 2: Take 2 Senokot-S tablets after breakfast.

If you do not have a bowel movement by evening,

Step 3: Take 3 Senokot-S tablets at bedtime.

If you do not have a bowel movement in the morning,

Step 4: Take 3 Senokot-S tablets after breakfast.

If there is no bowel movement within 48 hours after starting this protocol,

1. Add Milk of Magnesia after breakfast, while continuing to take 3 Senokot-S tablets in the morning and 3 Senokot-S tablets in the evening.

If there is no bowel movement within 24 hours after beginning Milk of Magnesia please consult your physician for additional instructions.

Once you start having bowel movements, use the two steps prior to your last one as your daily laxative protocol. For example, if you achieved a bowel movement after Step 4, use steps 2 and 3 (that is, 2 Senokot-S tablets in the morning and 3 Senokot-S tablets at bedtime) as your daily regimen.