Patients with post-operative ileus, opioid-induced constipation, or a soft stool will benefit from a stimulant laxative, such as senna or picosulphate. *In resistant cases, additional therapy can be given via manual evacuation.
In most experimental and clinical studies,99-102 giving nonsteroidal anti-inflammatory drugs resulted in decreased nausea and vomiting and improved gastrointestinal transit. Many clinicians use laxatives as a treatment for paralytic postoperative ileus.
An effective bowel regimen should include a stimulant laxative and a stool softener. These agents may include senna, bisacodyl, and docusate sodium.
Management of ileus starts with correction of underlying medical conditions, electrolyte abnormalities, and acid base abnormalities. Most cases of postoperative ileus resolve with watchful waiting and supportive treatment. Patients should receive intravenous hydration.
Get moving. As soon as your doctor says it's OK, get up and move around as much as possible. Even a short walk down the hospital hallway will help. Exercise helps move digested food through your intestines and signals your body that it's time for a bowel movement.
As soon as a doctor gives the go-ahead, people should start moving around. Going for short walks around the hospital or home or doing other physical activity will help move food through the intestines and stimulate a bowel movement.
Ileus Treatment
Your doctor might suggest: No food or fluids by mouth for 24 to 72 hours. Your doctor may also stop or cut back on strong pain relievers (opioid analgesics) or other medications that may be causing your symptoms. IV fluids to help correct any electrolyte imbalance.
GASTROINTESTINAL DYSFUNCTION WITH OPIOID USE
An “uncomplicated ileus” is caused by the neurohumoral stimulation that occurs during surgery and resolves spontaneously 2 to 3 days later. A more severe form, the paralytic postoperative ileus, lasts for more than 3 days after surgery.
Stimulant laxatives (i.e. sennosides, bisacodyl, sodium picosulfate) act on the intestinal mucosa, increasing water and electrolyte secretion and stimulating peristalsis. Stool softeners (i.e. docusate sodium or calcium) are thought to facilitate the mixing of aqueous and fatty substances and thereby soften the stool.
Signs and symptoms of an ileus can include abdominal pain, bloating, loss of appetite, and the inability to pass gas or stool.
Excessive doses of bulk-forming laxatives, or inadequate fluid intake with bulk-forming laxatives, cause intestinal obstruction rather than diarrhoea. If intestinal obstruction is suspected, do not use laxatives. Use of macrogol may result in a potential interactive effect if used with starch-based food thickeners.
The symptoms of ileus are abdominal bloating and pain caused by a buildup of gas and liquids, nausea, vomiting, severe constipation, loss of appetite, and cramps. People may pass watery stool.
Stool softeners – Take a Movicol sachet, once a day. You may increase this up to two sachets, twice a day if you are straining or have hard stools.
The use of enemas is contraindicated in patients with a paralytic ileus or chronic obstruction.
Treatment of an ileus requires time and supportive management. Bowel rest, intravenous (IV) fluid therapy, and, if warranted, nasogastric (NG) decompression are important steps. Historically these treatments were thought to lower complications and improve outcomes, but a recent review of the evidence shows otherwise.
Following abdominal surgery, a period of "physiologic" ileus is expected to last for 0 to 24 hours in the small intestine, 24 to 48 hours in the stomach, and 48 to 72 hours in the colon.
Conservative management. One of the most important steps in tackling ileus is early mobilization. That means getting patients out of the bed to walk in order to exert a mechanical stimulation of intestines.
You will need to avoid eating solid food until you are better. Instead, you will get fluids and nutrition through a vein (I.V.). This also lets your bowel rest. You may have a tube that goes through your nose and into your stomach.
If ileus persists, it can cut off blood supply to the intestines and cause tissue death. This can result in an intestinal tear or infection of the abdominal cavity that can be life threatening.
Remove stalks, stems, pips, seeds and skins from fruit and vegetables. Chop and cook vegetables well. Reduce tough, fibrous fruit and vegetables – chop these foods finely where possible (e.g. celery, mango). Avoid dried fruits, nuts and seeds.
Stimulant Laxatives
Some popular brands include bisacodyl (Correctol, Dulcolax, Feen-a-Mint), and sennosides (Ex-Lax, Senokot). Prunes (dried plums) are also an effective colonic stimulant and taste good, too. Note: Don't use stimulant laxatives daily or regularly.
Digital Stimulation involves inserting a finger or “dil stick” inside the rectum and moving it in a circular motion. This circular motion stimulates the bowel reflex and the rectal muscles open allowing the stool to leave the body. While a person may feel pressure with this technique, no pain should be felt.
How long will it take? Because of the gentle, natural mode of action, it can take a day or so after starting MOVICOL before you have your first bowel movement. But it will be a predictable and comfortable one, in harmony with the way your body works.