Improved Bowel Care With a Polyethylene Glycol Bisacodyl Suppository - Part 2
At the three year follow-up,16 patients continued to use PEGBS. Fifteen patients continued to note a shortening of bowel care time and 13 of these estimated the difference. (see Table 2.)
Table 1. Time required for bowel care using hydrogenated vegetable oil-based (HVOBS) vs polyethylene glycol-based (PEGBS) bisacodyl suppositories by report of the caregiver Initial trials
The nursing staff reported that three patients had discontinued PEGBS because of sweating, cramping or delaying fecal incontinence with this treatment. Although the documentation of complications was not systematic, another two patients had reported some rectal burning with PEGBS but had not discontinued its use. These patients had also noted burning with HVOBS.
Bisacodyl diphenyl acetate, when applied in a water solution as an enema, can enhance spikes of colonic pressure and induce coordinated peristaltic waves within minutes in neurologically intact subjects.6 When the drug is delivered by suppository, the onset of action depends upon the solubility of the suppository base in rectal fluid, shown to be much greater for polyethylene glycols than for a variety of oils.7 Clinically, the onset of bisacodyl activity is greatly enhanced by the substitution of polyethylene glycol for hydrogenated vegetable oil base.
The reduction in bowel care time by half is remarkably similar to previously reported experience with PEGBS.5 In fact, the simple substitution of one make of suppository for another has reduced bowel care time to durations comparable to those achived with colostomy (see table3.) In the three years since its introduction at our medical center, during which the use of PEGBS has become routine, these time savings have been maintained. Relief of the other complications of fecal retention -e.g., soilage, detention, dysreflexia, hemmorrhoids 8,9- was not examined in this study. The cholinergic drug cisapride will reduce large bowel transit time, but its final effect on bowel care time has not been reported.4 Pulsed irrigation has been used to clear fecal impaction, but its practicality for long term management has yet to be assessed.3 A comparison of all of these newer techiques for bowel care time, side effects and relief of complications would be of interest. It is concluded that the use of polyethylene glycol based bisacodyl suppositories reduces bowel care time by about 50 percent and can improve quality of life for the myelopathy patient.
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3. Puet TA, Phen L, Hurst DL. Pulsed irregation enhanced evacuation: new method for treating fecal impaction. Arch Phys Med Rehabil 1991;72:935-6
4. Longo WE, Woolsey RM, Vernava AM, Virgo KS, McKirgan L, Johnson FE. Cisapride for constipation in spinal cord injury patient:a preliminary report. J Spinal Cord Med 1995;18:240-44.
5. Stiens SA, Luttrell W, Binard JE. Redution in bowel program time with polyethylene glycol-based bisacodyl suppositories. J Spinal Cord Med 1995;18:299.
6. Schang JC, Hemond M, Herbert M, Pilote M. Changes in colonic myoelectric spiking activity during stimulation with bisacodyl. Can J Physiol Pharmacol 1986;64:39-43.
7. Parrott EL.Salicylate absorption from rectal suppositories. J Pharm Sci 1971;60:867-72
8. Saltzstein RJ, Romano J. The efficacy of colostomy as a bowel management alternative in selected spinal cord injury patients. J Amer Paraplegia Soc 1990;71:514-8
9. Stone JM, Wolfe VA, Nino-Murcia, Perkash I. Colostomy as treatment for complications of spinal cord injury. Arch Phys Med Rehabil 1990;71:514-8.
10. Stone M, Nino-Murcia M, Wolf VA, Perkash I. Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis. Am J Gastroenterol 1990;85:114-9.
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