What is a bowel routine?

A bowel routine is a schedule for taking medicines regularly to prevent or relieve constipation (trouble moving or emptying your bowels). These types of medicines are also called laxatives

Why do I need a bowel routine?

Having a bowel routine will help keep your movements regular. Being constipated can be uncomfortable and make you feel unwell. If you don’t treat your constipation, it can lead to serious medical problems.

Constipation can be a side effect of pain medicine (also called opioid analgesics, like codeine or morphine). Things that can make constipation worse include:

• chemotherapy
• some anti-nausea medicines
• eating less than normal
• not drinking enough fluids
• being less active

Preventing constipation is easier than treating it. Ways to prevent it include:

• Drink 8 cups of liquid each day. Your body needs liquid to help keep the stool soft.
• Do some light exercise, such as walking 15 – 20 minutes once or twice a day.
• Take laxatives, following a bowel routine.

The goal is to have a bowel movement every 2 to 3 days, or as close to your normal pattern as possible.

What medicines do I need for my bowel routine?

This bowel routine uses medicines that you can get in any pharmacy or drug store. You don't need a prescription. A few drug plans will cover the cost, so check your drug plan or ask your pharmacist for help. This routine uses:

Senokot

Senokot is a laxative that helps move stool through your bowel. It usually starts to work in 6 to 12 hours. It comes in pills or as a liquid. If you have trouble swallowing pills, you may either crush the pills and add 2 tablespoons (30 millilitres) of water to make medicine you can drink, or switch to the liquid form:

1 Senokot pill (8.6 milligrams) = 1 teaspoon of Senokot liquid (5 millilitres)

Lactulose

Lactulose is a syrup that helps to soften the stool before moving it through your bowel.

When do I start my bowel routine?

Start your bowel routine on the same day you are starting your pain medicine (such as codeine or morphine).

What is my bowel routine?

There are steps to the bowel routine to make it easy for you to change how much bowel routine medicine you need.

Where do I start?

• Start at step 1. If you are already following a bowel routine with a different laxative, please ask your nurse or pharmacist which step you should start at.
• If you are already constipated, your nurse may suggest you begin at a different step.

When do I move to the next step?

• If you don’t have a bowel movement after 2 days at step 1, go to step 2.
• If you don’t have a bowel movement 1 day after doing step 2, go to the next step.
• If you have a bowel movement that is comfortable to pass every 2 to 3 days when you are at a certain step, stay at the same step.

Bowel routine steps:

Step 1: Use a laxative

• Bedtime: Take 2 Senokot pills (or 2 teaspoons of Senokot liquid)

Step 2: Increase the laxative

• Morning: Take 2 Senokot pills (or 2 teaspoons of Senokot liquid)
• Bedtime: Take 2 Senokot pills (or 2 teaspoons of Senokot liquid)

Step 3: Increase the laxative and add another laxative medicine

• Morning: Take 3 Senokot pills (or 3 teaspoons of Senokot liquid) + 2 tablespoons of Lactulose
• Bedtime: Take 3 Senokot pills (or 3 teaspoons of Senokot liquid) + 2 tablespoons of Lactulose

Step 4: Increase the laxative

• Morning: Take 4 Senokot pills (or 4 teaspoons of Senokot liquid) + 2 tablespoons of Lactulose
• Lunchtime: Take 2 tablespoons of Lactulose
• Bedtime: Take 4 Senokot pills (or 4 teaspoons of liquid) + 2 tablespoons of Lactulose

Step 5: Add a suppository

• Morning: Take 4 Senokot pills (or 4 teaspoons of liquid) + 2 tablespoons of Lactulose + Bisacodyl (DULCOLAX®) 10mg suppository. Keep the suppository in place for a least 15 minutes.*
• Lunchtime: Take 2 tablespoons of Lactulose
• Bedtime: Take 4 Senokot pills (or 4 teaspoons of liquid) + 2 tablespoons of Lactulose

* Do not use a suppository if you have a low white blood cell count (which fight infection) or low platelets (which help the blood to clot). Check with your nurse if you are unsure about this.

IF YOU ARE STILL CONSTIPATED after following these 5 steps, please talk with your nurse, you may need a different kind of medicine or to make other changes. Don't take more than 8 Senokot pills a day.

Important information:

Your nurses or doctor may recommend other medicines to help you with your bowel routine. Ask your health care team for more information about these medicines:

• Docusate sodium, also called Colace®, is a stool softener. You may be asked to take this in addition to the bowel routine medicines. You can take 2 pills with each meal, up to 6 pills a day.
• Polyethylene Glycol 3350 (PEG), also called Lax-a-Day, PEG flakes, or RestoralAX. This is a powdered laxative that you mix into a cup of water and drink.

I am having loose or runny stool. Should I stop my bowel routine?

If you start to have loose or runny stools, don’t stop your bowel routine. Just go back to the previous step. Using these steps lets you change your bowel routine when you need to. Call or speak to your nurse and let them know what’s happening.

How can I prevent constipation from my chemotherapy and anti-nausea medications?

On the day of your chemotherapy, go to the next step of your bowel routine to prevent constipation. For example, if you are on step 2, go to step 3 on the day you get your chemotherapy medicine. You can stay on step 3 or change it in a couple of days if you need to.

Remember:

• If you don’t treat your constipation, it can lead to serious medical problems. Talk to your doctor, nurse or pharmacist if you have concerns about your medicines, bowel movements, or have any side effects that concern you.
• Normal or regular bowel movements are what was normal for you before starting treatment. If it’s normal for you to have a bowel movement every day, you should still have a bowel movement at least every 2 to 3 days while taking pain medicines.
• If you don’t have a bowel movement within 4 days, call your nurse to review what you are taking. They can suggest changes.
• Tell your doctor or nurse how you are doing on the bowel routine at your clinic appointment.
• Senokot may affect how other drugs work. Take it 1 hour before or 2 hours after other medicines, if possible.