Bowel regimen
Formal Definition
A structured pharmacological approach to prevent and treat constipation in hospitalized or opioid-taking patients, typically combining a stool softener (docusate) with a stimulant laxative (senna or bisacodyl); considered a mandatory adjunct to any opioid prescription and a standard order for post-operative and immobilized patients.
How It's Used on the Ward
"Start a bowel regimen" or "bowel meds" — the automatic constipation prevention protocol whenever opioids are prescribed.
Example
""Post-op day 2, no BM yet, on scheduled oxycodone: adding senna-docusate twice daily. If no BM by post-op day 3, escalate to bisacodyl suppository or MiraLAX. Opioid-induced constipation is universal — do not wait for symptoms before starting prophylaxis.""
Clinical Context
Opioid-induced constipation (OIC) affects up to 90% of opioid-using patients and is the most common opioid side effect that does not improve with tolerance. First-line: stimulant laxative (senna) + stool softener (docusate). Do NOT use docusate alone (insufficient for OIC). Escalation: osmotic laxatives (PEG/MiraLAX, lactulose), rectal agents (suppository, enema). For refractory OIC: peripherally acting mu-opioid receptor antagonists (methylnaltrexone/Relistor or naloxegol). Ileus (no bowel sounds, distension, no flatus) is different from constipation — do not give stimulant laxatives into a potential obstruction without imaging.
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