What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?

I am a radiation oncologist and palliative care physician.

I teach: "the hand that writes the opioids, writes the laxatives - or else it does the disimpaction".

Opioid induced constipation is very common, can cause physical and psychological discomfort, and have a major impact on quality of life. It ...

I'm going piggyback on the "mush no push" idea.

I put all opioid naive patients on a "Musher", a stool softener and a "pusher", a bowel stimulant.

Using both tackles the two causes of opioid induced constipation: Decreased peristalsis which increases colonic transit and water extraction in the colon...

I generally tell patients that my goal is for them to have a BM as per their baseline while on opioids. For most, this is once per day, but may be once every other day, or occasionally once every 3rd day, depending on the person. Going forward, I am assuming that the patient's baseline is once per d...