Bowel Management in Patient taking Opioids
1.
Constipation occurs in EVERYONE taking opioids (narcotics). You need routinely, a `pusher' (a
laxative that increases peristalsis) eg, Senokot and a softener from the first dose of opioid. Opioids
slow the bowel down. Your `pusher' speeds it up again. It puts the `push' back that the opioid has
taken out. Take it EVERY day.
2. Never use bulk forming laxatives such as Metamucil for constipation caused by
opioids. There are receptors in the bowel wall that are sensitive to distention. In the
normal bowel when there is bulk in the diet, these receptors are stimulated and the
bowel contracts ­ ie peristalsis ­ a wave of contraction - passes along the bowel wall
pushing the contents onwards. These receptors are paralyzed by opioids, so they
cannot respond to bulk. It is therefore very important to use a laxative that increases
peristalsis ­ not one that is bulk forming.
3. The commonest cause of nausea and vomiting after that time is poor bowel
management. Prevent it happening in the first place by taking your ,,pusher and
softener regularly. The commonest cause of nausea and vomiting after that time is
poor bowel management. Prevent it happening in the first place by taking your
,,pusher and softener regularly. Senokot 1-3 tablets q 12 hours plus softener is one
protocol. Senokot-S is Senokot and stool softener combined.
Day 1
Senokot 1 tablet q 12 hours
Softener 1 capsule q 12 hours
Day 2
If bowels not moved:
Senokot 2 tablets q 12 hours
Softener 2 capsule q 12 hours
Day 3
If bowels not moved:
Senokot 3 tablets q 12 hours
Softener 3 capsule q 12 hours
As a ,,rule of thumb if you go 3 days without a bowel movement take 30mls Milk of
Magnesia. This is NOT a "pusher", and does not replace the ,,pusher it merely
draws water into the bowel. It DOES NOT INCREASE PERISTALSIS. This gives
time for the "pusher to be increased to an appropriate level and the bowels
managed effectively.

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