Key Practice Points

• In patients with cancer, it is very important to take a preventive approach and teach patients how to manage bowel function before symptoms begin.

• It is crucial to involve the patient as a partner in bowel management.

• Thorough assessment of bowel function and a thorough bowel history are the most important steps in bowel management, permitting correct diagnosis of the cause of bowel dysfunction and thus permitting appropriate treatment.

• In any bowel management program, fluid, fiber, food, and medication are the 4 components that must be balanced.

• Fecal impaction is often caused by recent diagnostic procedures using barium. This type of impaction can be prevented by routinely prescribing a laxative to be taken until evidence of barium excretion abates. If a patient is at high risk for barium retention, a request that barium not be used for this patient is appropriate, and gastrographin should be used as a substitute.

• If a patient's colon is packed with stool, 1 enema is not sufficient to normalize the colon. Enemas need to be repeated 4 times a day until no more formed stool is eliminated.

• Medicinal fiber can be used to treat diarrhea or frequent stooling. However, the label directions for taking supplemental medicinal fiber apply only to the treatment of constipation. Patients must be alerted to this fact and given special written instructions for use of fiber to treat frequent stooling.

• During treatment, bowels can be managed using a symptom management approach.

• A formal bowel training program should not be started until (1) treatment with side effects on the GI tract is completed and (2) the bowel has been brought back to a normal state, without constipation or impaction and with no liquid stools.

• After treatment, a long-term bowel management program can be initiated for maintaining regular bowel functions.

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