Management of opioid-induced bowel dysfunction.

Opioid-induced bowel dysfunction is a major complication in oncology practice and must be approached aggressively. Every patient starting opioids should be thoroughly instructed in the management of this side effect. Prevention is the key and use of agents such as senna and a stool softener with the initiation of therapy is mandatory, with rapid titration if the initial dose is not effective. At the first sign of constipation, agents such as bisacodyl should be added rapidly. Other agents then can be added as necessary. Fecal impaction must always be considered and it should be recognized that it may lead to other symptoms such as increased pain, urinary difficulties, or nausea and vomiting. In summary, the words of Dame Cicely Saunders, founder of the hospice movement, must be kept in mind: "Remember the bowels".