James H. Frisbie, MD
Abstract : To test its effectiveness for bowel care in myopathy, a bisacodyl suppository based in polyethylene glycol (PEGBS) was compared with a conventional bisacodyl suppository based in hydrogenated vegetable oil (HVOBS). Nineteen patients with upper motor neuron paralysis received 57 HVOBS and 114 PEGBS trials in a crossover design. The average time for complete bowel evacuation was 2.4 (range 1.0 to 4.5) hours with HVOBS and 1.1 (range .03 to 1.8) hours with PEGBS. Three patients later discontinued the PEGBS because of cramps or fecal incontinence. The remaining 16 patients continued to use PEGBS for three years and 15 reported a sustained savings in time. It is concluded that the replacement of HVOBS with PEGBS will reduce bowel care time in myopathy patients by about half. (J Spinal CordMed1997;20:227 229) Key words: spinal cord injury, constipation, large bowel, colon.
Colonic dysfunction in myopathy patients 1 is mainifested by prolonged bowel care time, often more than two hours per session, one of the more time consuming aspects of personal care. 2 Recently, methods of improved bowel care have been reported.3-5 One of there, the use of a bisacodyl suppository based in polyethylene glycol instead of the ususal hydrogenated vegetable oil, reduces the time needed for bowel care.5 The value of this modified suppository is reexamined in this report.
Trials. The effectiveness of the commonly used suppository, bisacodyl diphenyl acetate, 10mg, in a hydrogenated oil (Dulcolax Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CN) was compared with that of the new suppository, containing the same quantity of bisacodyl in a polyethylene glycol base (Magic Bullet, Great Southern Laboratories, Houston, TX.) Hydrogenated vegetable oil-based bisacodyl suppositories (HVOBS) were used for one to two weeks with frequency of two to three times per week in combination with usual laxatives and digital stimulation of the anal ring for each individual.
1 Spinal Cord Injury Services, Department of Veterans Affairs Medical Center, Brockton, MA. Correspondence: James H. Frisbie, MD 1400 Veterans of Foreign Wars Parkway West Roxbury, MA 02132 Trial medication was furnished by the hospital pharmacy service. Received: October 8,1996 Accepted: December20, 1996
The time , to the nearest minute between the insertion of the suppository and the completion of bowel evacuation and cleanup was measured. Polyethylene glycol-based bisacodyl suppositories (PEGBS) were then substituted for HVOBS for two weeks and the times for bowel evacuation again measured. Caregivers were not blinded in the use the suppositories.
Subjects. Nineteen myelopathy patients with upper motor neuron lesions due to spinal cord injury, whose bowel care regimens included the insertion of bisacodyl suppositories and who agreed to participate in the trials with the modified suppository, were the subjects of the trial. The level of paralysis was cervical in 15 and thoracic (T1-7) in four. The grade of paralysis was motor complete in 15. The average age was 64, range 41 to 81, years. The average duration of paralysis was 19, range three to 51years. Patients were interviewed three years after the trials with PEGBS to determine continued use, their perception of the duration of bowel care and complications. Thus, the initial trials with PEGBS were prospective and follow-up was retrospective.
There were 57 trials with HVOBS and 114 with PEGBS. When HVOBS were used, nine patients required two suppositories inserted for each bowel care session. When PEGBS were used, the doses were sometimes reduced to prevent complications so that finally 16 patients used one and three used two suppositories for each bowel care session. All patients experienced a shortening of bowel care with PEGBS (See table 1.)
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