Helpful tips for the prevention of constipation:

Increase fluid intake.

Increase fiber intake (bran, vegetables, whole grains).

Increase physical activity.

Head to the bathroom immediately if you have any urge for a bowel movement, especially after breakfast, a hot drink in the morning may help.

Take a laxative along with opioid pain medication.

Treatment of Constipation

Senna Laxative (Either name brand Senokot or a generic alternative)

Senna is a natural vegetable fiber laxative tablet and is commonly used in cancer patients or patients with constipation from opioid pain medication. It is available over the counter as brand name Senokot or multiple other generic formulations such as senna, senna tabs, senna syrup and senna tea. It is also sold in combination with a stool softener, such as Senokot-S, senna plus, and other names.

Start with 1 to 2 tablets daily to prevent constipation and increase as needed. To treat constipation start with 2 tablets twice a day until there is a bowel movement, then decrease or increase the dose as needed. Everyone's bowels are different, some patients require no medication for constipation, other may require up to 12 tablets a day.

In general, Senna laxative are safe and effective, even for long term use, though the box will likely say to only use up to one week.

Miralax (polyethylene glycol)

This is a laxative powder mixed with liquid to take daily. It can be purchased over the counter. Start with a tablespoon of Miralax mixed in a glass of water or any liquid. This medicine is the same patients take in larger quantity when preparing for a colonoscopy. Miralax appears safe for long term use, though the bottle will likely say to only use up to one week. Some patients may require both Senokot and Miralax to prevent and treat constipation.

Colace

This is a stool softener and is largely ineffective for the treatment of cancer patients with constipation, but can be tried.

Milk of Magnesia, Magnesium Citrate

These are over the counter liquids that contain magnesium and other electrolytes to pull water into the intestine. They are effective treatments for constipation. They should be used cautiously in cancer patients, and should be avoided in patients with kidney impairment.

Lactulose

This a prescription medication. It is a non absorbed sugar that pulls water into the intestine. It can be used in refractory cases of constipation. Dosing is 2 to 4 tablespoons (30 to 60 ml) once or twice a day. Onset of action is usually 4 hours, but can take 1 to 2 days.

Mineral Oil

Avoid this, as cases of unintentional mineral oil inhalation and lung injury have occurred.

Relistor (Methylnaltrexone)

This is an option for patients with constipation induced by opioid pain medications. It is a subcutaneous shot. 60% of patients can expect to have a bowel movement within 4 hours of receiving this shot. It can be used every other day, but no more frequently than once every 24 hours.

Amitiza (lubiprostone)

This is a medication used to treat chronic constipation (24 mcg bid) and irritable bowel constipation (8 mcg bid). It may obtain FDA approval in the near future for treatment of opioid pain medication induced constipation.