From the Guidelines
A good bowel regimen should include a stimulant laxative or a heaping tablespoon (17 g) of polyethylene glycol with 8 oz of water 2 times daily, along with maintaining adequate fluid intake, as recommended by the NCCN Guidelines for Adult Cancer Pain Panel Members 1. When managing constipation, it's essential to consider the underlying cause and the patient's overall health status.
- For patients taking opioids, a prophylactic bowel regimen is recommended to prevent constipation, as it can almost always be anticipated with opioid treatment 1.
- The use of docusate as a stool softener has not shown benefit and is therefore not recommended 1.
- Maintaining adequate dietary fiber intake is recommended, but supplemental medicinal fiber, such as psyllium, is ineffective and may worsen constipation 1.
- In patients with a limited life expectancy, the focus should be on managing symptoms and improving quality of life, rather than solely on preventing constipation 1.
- The NCCN Guidelines for Palliative Care recommend a stepped approach to managing constipation, including increasing fluids, dietary fiber, and exercise, as well as administering prophylactic medications and treating underlying causes 1.
- For patients with a shorter life expectancy, more intensive interventions may be necessary, including the use of laxatives, suppositories, and enemas 1.
From the FDA Drug Label
Directions Put one dose into an empty glass. Mix this product (child or adult dose) with at least 8 ounces (a full glass) of water or other fluid. Stir briskly and drink promptly. If mixture thickens, add more liquid and stir. For a lighter flavor experience and thinner drink, use more water. Adults 12 yrs. & older 1 packet in 8 oz of liquid at the first sign of irregularity. Can be taken up to 3 times daily. New Users:Start with 1 dose per day; gradually increase to 3 doses per day as necessary.
A good bowel regimen may include:
- Taking 1 packet of psyllium in 8 oz of liquid at the first sign of irregularity
- Starting with 1 dose per day and gradually increasing to 3 doses per day as necessary
- Drinking plenty of water, at least 8 ounces per dose
- Adjusting the amount of liquid to achieve a lighter flavor experience and thinner drink if needed 2
From the Research
Components of a Good Bowel Regimen
- A high-fiber diet, with a daily intake of 40 to 50 grams of fiber, can alter the composition of the gut microbiome and increase the abundance of fiber-degrading bacteria, such as Bifidobacterium and Lactobacillus 3
- Dietary fiber intake is associated with overall metabolic health, including insulin sensitivity, and a variety of other pathologies, such as cardiovascular disease, colonic health, and risk for colorectal carcinoma 4
- Psyllium is an excellent dietary source of both soluble and insoluble fibers and has been used in supplemental and food products for its beneficial health effects 5
Dietary Recommendations for Bowel Health
- There is no evidence to restrict dietary fiber 1 day before colonoscopy, and a split-dose bowel regimen can be used with an unrestricted diet more than 1 day before colonoscopy 6
- IBD patients may be able to increase dietary fiber intake with short-term benefit and good tolerability, particularly when fiber is introduced during clinical remission 7
- A diet rich in fiber-replete plant-based foods and low in ultra-processed foods can help promote overall metabolic health and reduce the risk of various pathologies 4
Foods that Support Bowel Health
- Gelatin consumption has been positively associated with bowel preparation quality, while red meat, poultry, and vegetables have been inversely associated with bowel preparation quality on the day before colonoscopy 6
- Psyllium can be used as a dietary supplement to increase fiber intake and promote bowel health 5