Contributed by Gary Fisher
- Please consult a member of the Pharmaceutical team before taking any additional medication to your prescribed regime.
- EXERCISE – To be undertaken only following consultation with a healthcare professional
- DIETARY – Start with bland food, keep a food diary, introduce new foods slowly, care with greasy and spicy foods. Loperamide 2mg is useful in slowing/reducing the frequency of bowel motions.
It is important to maintain a good hydration level (3-4 litres of clear fluid daily). A good indicator is when passing water, excluding the first sample of the day, urine should be clear and colourless, the deeper the colour, the lower the hydration level. Sipping small quantities of a clear liquid regularly is more beneficial than large quantities irregularly. Where sections of large bowel have been removed, it is imperative to maintain a good hydration level, since re-absorbing fluid is one role of the large intestine.
Macmillan supply a card that promotes access to non-public toilets
- SLEEPLESSNESS – Before resorting to additional medications, lifestyle measures may be sufficient, many ideas are listed here,
Promoting and maintaining a good sleeping habit is the aim. Obtaining that aim can be achieved through many different angles. It is important to remember that medications should only be used to achieve the good sleeping habit.
- Lifestyle issues as listed above
- OTC medicines, Promethazine, Diphenhydramine etc.
- Alternative therapies, Chamomile, Lavender etc.
- Prescription Only Medicines (P.O.M.) – available only on prescription from a medical practitioner.
- CONSTIPATION – This may not be an issue if part of the bowel has been removed and slowing motility is then the issue, however, for many people it can be troublesome and a sensitive subject.
Here it is important to consider the cause of the situation, be it drug induced (opiate products, sympathomimetic, etc.), lifestyle or the bowel condition and act appropriately.
Bowel function varies between individuals and if a regular pattern is present, normality usually ensues. The myth of having to pass a motion after breakfast once daily must be dismissed. Normal bowel function may range between five times a day, to once every three days if regularly obtained.
Maintaining a good hydration level is important and when obtained may be sufficient to maintain a good bowel habit. If motions are not being passed regularly, bowel function can be aided by,
- Good hydration
- Osmotic laxatives, whereby the bowel mass is increased by liquid measures to stimulate the bowel into passing a motion. This can be as simple as drinking glasses of fruit juice with copious quantities of water or by using various proprietary brands of salts or strong sugar solutions such as lactulose.
- Faecal softeners, work in a similar way to osmotic laxatives and by preventing the hardening of the faecal mass, promotes its passing. Docusate Sodium and Glycerol are examples.
- Bulk forming laxatives again work in a similar way to the osmotic laxatives, here by being an indigestible mass such as ispaghula husk and sterculia which increase the bowel mass when used with copious quantities of water.
- Stimulant laxatives, should be used only if other measures have not produced an end product. These agents such as Bisacodyl, Senna and Cascara stimulate various parts of the bowels to contract, thereby aiding the peristaltic action of the bowels.
Laxatives can be used by oral methods or if required by rectal administration via an enema or suppository.
- SKIN PRURITUS (ITCHY SKIN)
Can be treated either systemically with antihistamines (e.g. chlorphenamine) or topically.
The condition may or may not be associated with a rash. The important issue is not to exacerbate the situation. Often, a cold object such as an ice block or even a packet of frozen vegetables, wrapped in a cotton covering (to prevent ice burn or frost bite) for 5-10 minutes every half hour is sufficient. Proprietary preparations containing local anaesthetics (e.g.benzocaine and lidocaine), crotamiton and lauromacrogols are effective and can be purchased in cream, powder, lotion, ointment and gel forms.
It is important to cool warm skin before applying any medication, as the heat from the skin can combine with lipids to “cook” the affected area, thereby imparting further damage.