Experience with Glycerin for Antegrade Continence Enema in Patients with Neurogenic Bowel

Abstract

Purpose Malone antegrade continence enemas are used in the management of neurogenic bowel to attain fecal continence. Several different irrigation solutions have been described but glycerin, an osmotic laxative that promotes peristalsis, has rarely been mentioned or studied. We assessed clinical outcomes in our patients with a Malone antegrade continence enema using glycerin based irrigation. Materials and Methods We retrospectively reviewed patients with neurogenic bowel who underwent a Malone antegrade continence enema procedure between 1997 and 2011. Glycerin diluted with tap water followed by a tap water flush is our preferred irrigation protocol. Bowel regimen outcomes examined included fecal continence, emptying time, leakage from stoma, enema volume, frequency and independence. Results Of the 23 patients with followup greater than 6 months 19 used glycerin based irrigation. Average age at surgery was 8.8 years. Patients using glycerin instilled a median of 30 ml (mean 29) glycerin and 50 ml (131) tap water. Fecal continence rate was 95% and stoma leakage rate was 16%, and only 16% of patients required daily irrigation. Conclusions Glycerin is a viable and effective alternative irrigant for antegrade enemas of neurogenic bowel, with an excellent fecal continence rate. The volume of irrigant needed is typically less than 90 ml, which is much less than in published reports using tap water alone.

High amplitude propagated contractions with Glycerin versus Bisacodyl: A within‐subject comparison in children undergoing colonic manometry

“…HAPCs can occur during the fasting state (more frequent in younger children), postprandially as a normal response to feeds (provided that there is an adequate caloric intake (at least 10 kcal/kg) or 400 kcal; >30% kcal from lipids) 20 and poststimulation by colonic stimulants administered in the colon as an enema (antegrade or retrograde) 5,6,9 . The most commonly used medications for colonic stimulation are Bisacodyl and Glycerin, both of which induce colonic contractions and bowel movements 11,12,22,23 . Bisacodyl is most often used in CM protocols as there have been no previous studies that compare the stimulatory effect of both medications.…”

“…9 Both Bisacodyl and Glycerin have been widely used successfully in bowel regimens in patients with constipation as a method of disimpaction as well as to prevent fecal incontinence in patients with neurogenic bowel. 6,11,12 Motility centers use Bisacodyl rather than Glycerin while performing CM as per guidelines. 5,8 Bisacodyl stimulates sensory nerve endings to increase colonic peristalsis as well as inhibiting intestinal water absorption.…”

“…17 When administered into the colon, Glycerin is thought to act as an osmotic laxative and a stimulant which produces HAPCs. 11 A headto-head comparison of the stimulatory effects of each drug has never been studied. In this study, we aim to compare the HAPC characteristics of Bisacodyl and Glycerin in children undergoing CM studies.…”

Neurogenic Bowel Dysfunction in Patients with Neurogenic Bladder

“…Flushes are commonly performed with large volumes of tap water, but additives such as enemas, GoLYTELY, mineral oil, MiraLAX, and glycerin can augment the routines for those with refractory incontinence (45), (46). …”

Pediatric Spinal Cord Injury

“…The ACE procedure entails using the appendix or other segment of intestine to connect a stoma on the abdominal wall with the large intestine. The patient or caregiver can insert a catheter through the stoma and flush a small quantity of irrigant (typically water or glycerin water mixture) to stimulate peristalsis [40]. While there have been numerous reports of improved bowel management in children with myelomeningocele, few outcome studies have included children with SCI [41].…”