It cannot be stressed strongly enough that rectal examinations must be carried out on all patients to decide on the appropriate treatment required. In tumours of the bowel that cause a restricted lumen, the stools should be kept as soft as toothpaste. Use laxatives with softening properties, such as docusate sodium 8-12 tablets a day. Maintain adequate fluid intake and avoid non-digestible foods, fruit peel and pith. Surgical intervention is the obvious treatment for mechanical obstruction.
Many patients find the prospect of a colostomy or ileostomy unacceptable.
This should be taken into account when surgery is considered. However, it must be borne in mind that a patient with recurrent malignant disease may have multiple sites of obstruction, which would not be amenable to surgical resection.