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 patients do not develop tolerance to constipation 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 addition to laxatives, maintaining adequate fluid intake and regular physical activity can help promote regular bowel movements.
- Establishing a regular bathroom routine, ideally after meals when the gastrocolic reflex is strongest, can also help promote regular bowel movements. It's crucial to note that the management of constipation may vary depending on the patient's estimated life expectancy and overall health status, as outlined in the palliative care guidelines 1.
- For patients with a longer life expectancy, increasing fluids, dietary fiber, and exercise, as well as administering prophylactic medications, may be recommended 1.
- For patients with a shorter life expectancy, more intensive interventions, such as the use of glycerine suppositories, mineral oil retention enemas, and manual disimpaction, may be necessary 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
Bowel Regimen Components
- A good bowel regimen may include a diet rich in dietary fiber, which has been shown to have numerous health benefits, including promoting overall metabolic health and supporting gut motility 3
- Psyllium, a type of soluble fiber, has been found to be an effective component of a bowel regimen, with benefits including improved glycemic control, lowered serum cholesterol, and facilitated weight loss 4, 5
Benefits of Dietary Fiber
- Dietary fiber has been associated with a range of health benefits, including:
- Improved insulin sensitivity
- Reduced risk of cardiovascular disease
- Enhanced colonic health
- Reduced risk of colorectal carcinoma
- Lower mortality rates 3
- The gut microflora plays a key role in mediating the beneficial effects of dietary fiber, including regulating appetite, metabolic processes, and chronic inflammatory pathways 3
Effective Use of Psyllium
- Psyllium has been shown to be effective in facilitating weight loss in overweight and obese individuals when dosed just before meals, with a mean dose of 10.8 g/day and a mean duration of 4.8 months 5
- The gel-forming properties of psyllium make it a useful component of a bowel regimen, slowing the degradation and absorption of nutrients in the small intestine and promoting feelings of fullness and satiety 5