POLYETHYLENE-GLYCOL VERSUS VEGETABLE OIL-BASED BISACODYL SUPPOSITORIES TO INITIATE SIDE-LYING BOWEL CARE - A CLINICAL-TRIAL IN PERSONS WITHSPINAL-CORD INJURY

Introduction: Neurogenic bowel dysfunction resulting from spinal cord injury (SCI) frequently requires bowel care (BC) with stimulant suppos itories for initiation of effective defecation. The excessive time req uired for BC and bowel complications have limited quality of life afte r SCI. Objective: To test the hypothesis that: the time required for b owel care with bisacodyl suppositories can be reduced by substituting a polyethylene glycol base (PGB for the traditional hydrogenated veget able oil base (HVB) in the suppository. Setting: inpatient SCI medicin e unit. Subjects: Fourteen persons with SCI with chronic stable paraly sis from upper motor neuron SCI for greater than one year with a stabl e HVB bisacodyl suppository initiated BC. Design: Crossover Controlled . Method: Subjects received HVB bisacodyl suppositories for six sequen tial BC sessions and then were crossed over to PGB bisacodyl supposito ries for six more BCs. Outcome measures: BC event times were utilized to derive BC intervals: suppository insertion to first flatus = Time t o flatus, first flatus until the beginning of stool flow = Flatus to s tool flow, begin stool flow until end stool flow = Defecation period e nd stool flow until end of clean up = Clean up, and suppository insert ion until end clean up = Total bowel care time. Results: The data incl uded two groups of BC sessions: HVB (n = 84) and PGB (n = 81). Mean ti mes in minutes and P values from t tests for paired samples yielded: T ime to flatus: (HVB 31, PGB 12.8 P < 0.002), Defecation period: (HVB 5 8, PGB 32, P < 0.0005), Clean up: (HVB 1.9, PGB 3.2 P = 0.165), Total bowel care time: (HVB 102, PGB 51.2 P < 0.0005). Conclusion: This anal ysis suggests that PGB based bisacodyl suppositories may stimulate ref lex defecation sooner and shorten the Total BC Time as compared with H VB bisacodyl suppositories.