To avoid diarrhoea, this is later reduced to a smaller maintenance dose. 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.