Pharmacologically initiated defecation for persons with spinal cord injury: Effectiveness of three agents

Abstract

Objective: To compare the effectiveness of hydrogenated vegetable oil-based bisacodyl (HVB) suppositories, polyethylene glycol-based bisacodyl (PGB) suppositories, and polyethylene glycol-based, glycerine, docusate sodium mini-enemas (TVC) in subjects with upper motor neuron spinal cord lesions. Study Design: Prospective randomized double blind. Fifteen subjects received one of 3 HVB and 3 PGB suppositories in randomized sequence for each of six scheduled bowel care sessions. Additionally, 10 subjects received 3 TVC. The analysis used timed events that divided the bowel care sessions into discrete intervals. The analysis also compared digital simulations, incontinence, and quantity of stool. Wilcoxon rank sum tests and paired t tests were used to compare the means of intervals during bowel care initiated by HVB, PGB, and TVC. Results: (means in minutes and p values): Time to Flatus—HVB, 32; PGB, 15; TVC, 15; p < .026, HVB-PGB; p < .983, PGB-TVC; Flatus to Stool Flow—HVB, 6.7; PGB, 5.5; TVC, 3.9; p < .672, HVB-PGB; p < .068, PGB-TVC; Defecation Period—HVB, 36; PGB, 20; TVC, 17; p < .037, HVB-PGB; p < .479, PGB-TVC; Wait Until Transfer—HVB, 10.9; PGB, 10.7; TVC, 7.4; p < .932, HVB-PGB; p < .043, PGB-TVC; Total Time for the bowel program—HVB, 74.5; PGB, 43; TVC, 37; p < .010, HVB-PGB; p < .458, PGB-TVC; percent incidence of incontinence between bowel care sessions—HVB, .067; PGB, .067; TVC, .033; p < 1.0, HVB-PGB; p < .678, PGB-TVC; amount of stool produced—HVB, 3.30; PGB, 3.49; TVC, 3.38; p < .276, HVB-PGB; p < .630, PGB-TVC; average number of digital stimulations per bowel care procedure—HVB, 4.4; PGB, 4.1; TVC, 3.8; p < .411, HVB-PGB; p < .293, PGB-TVC; time per digital stimulation in seconds—HVB, 107; PGB, 40; TVC, 83; p < .149, HVB-PGB; p < .352, PGB-TVC; and the total time, in minutes, spent performing digital stimulations during bowel care—HVB, 10.0; PGB, 2.7; TVC, 5.9; p < .151, HVB-PGB; p < .325, PGB-TVC. Conclusion: Bowel care took less time when initiated with the PGB bisacodyl suppository or TVC mini-enema as compared with the HVB bisacodyl suppository ( p < .01).