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Flexible endoscopy
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Pierre H Chapuis, D Brian Jones
In patients suspected of having inflammatory bowel disease (IBD) who present with diarrhea, flexible sigmoidoscopy should be performed preferably without prior preparation. For other patients, administration of a disposable enema will usually suffice. These may be simple tap water or commercially available enemas which contain sodium phosphate (Fleet) or sodium citrate (Microlax®).
Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2013
Docusate – Dioctyl – an anion surfactant which probably acts as faecal softener as well as stimulant laxative. It does pass into breastmilk according to the BNF although the amount is unknown. As this drug is minimally absorbed from the GI tract the amount in breastmilk is likely to be extremely small. It is licensed for use in children over the age of 2 years. US brands: Colace, Dioctyn, Docusoft Australian brands: Coloxyl, Rectalad Compatible with breastfeeding in normal doses. Laxative enemas or suppositories Laxative enemas or suppositories may be given in extreme cases of constipation – these would not be absorbed systemically. They act within an hour of use but are generally only used as an acute measure and rarely in younger patients. There is no contra-indication in breastfeeding. Phosphate enema – Fletchers, Fleet Sodium citrate enema – Microlax, Microlette Glycerine suppositories Compatible with breastfeeding as not absorbed systemically. 128
Faecal Incontinence
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
P. Ronan O’Connell, Thomas Dudding
Regular rectal emptying through use of laxatives, enemas or retrograde irrigation is important when managing constipation and overflow incontinence in patients with spinal cord or other neurological conditions77; however, there are relatively few high-quality studies of using such techniques for incontinence of other aetiologies. Glycerin suppositories or an irritant suppository, such as bisacodyl (Dulcolax®), may be helpful, but they rarely achieve complete clearance of the rectum. Disposable phosphate enemas are more efficient, but patient compliance is less due to ongoing faecal leakage. There are a variety of small volume proprietary enemas based upon the laxative effect of sodium citrate that may be self-administered (Microlax®, Micralax®). In general, these are rarely of use unless constipated stool and failure to evacuate are the predominant issues. Some patients, who wish to avoid surgery or a stoma, are willing to use high-volume enemas on a regular basis in order to keep the rectum empty. The success of this approach is largely determined by motivation. The Peristeen® anal irrigation and the Qufora® IrriSedo Cone systems provide a useful option for well-motivated patients and are particularly useful in patients with spinal cord injury or autonomic neuropathy.78 An alternative is ante grade irrigation using either an appendicostomy or continence colonic conduit.79–81 These techniques have application for evacuatory disorders complicating anorectal malformation or variants of Hirschsprung’s Disease but are rarely of value in an adult population outside of these indications.
Anal sphincter dysfunction in patients treated with primary radiotherapy for anal cancer: a study with the functional lumen imaging probe
Published in Acta Oncologica, 2018
Susanne Haas, Pia Faaborg, Donghua Liao, Søren Laurberg, Hans Gregersen, Lilly Lundby, Peter Christensen, Klaus Krogh
Both groups were evaluated using standard anal manometry and anal FLIP. Subjects were examined after two hours fasting and with an empty bladder. An enema (Microlax, McNeil, Birkerød, Denmark) was administered at least 15 minutes prior to the investigation, ensuring that the rectum was empty. All examinations were done with the subject in the left lateral position. Standard anal manometry and rectal bag volume distension (Menuet, Dantec medicals, Bristol, UK) was performed in accordance with a previous publication from our unit [33].
The usual bowel care regimes of people living in the community with spinal cord injury and factors important for integrating bowel care into everyday life
Published in Disability and Rehabilitation, 2022
Julie Pryor, Denise Haylen, Murray J. Fisher
While study participants were prescribed bowel care regimes in hospital, integrating these regimes into daily life meant being flexible and adapting the process when needed to solve problems and continue to achieve the aims of their bowel care in their own life situation. This included managing work schedules, changing life circumstances or adjusting to age-related changes in their bowel function. P4 fine-tuned his use of Microlax enemas:
MRI-only based radiation therapy of prostate cancer: workflow and early clinical experience
Published in Acta Oncologica, 2018
Mikko Tenhunen, Juha Korhonen, Mika Kapanen, Tiina Seppälä, Lauri Koivula, Juhani Collan, Kauko Saarilahti, Harri Visapää
CT images were scanned with the four-slice helical CT simulator with a flat table top (GE Lightspeed RT, GE Healthcare, MARLBOROUGH, MA) using 2.5 mm slice thickness covering patient outline and pelvic structures. Patients emptied their rectum with micro-enema (5 ml MICROLAX®) before imaging and bladder size was controlled by guiding patients to empty their bladder 1 h before imaging and then drink two glasses of water.