Medication Summary
Drugs used for management of neurogenic bowel dysfunction (NBD) include laxatives and stool softeners aimed at stimulating peristalsis with subsequent loosening and expulsion of feces.
Colonic stimulants
Class Summary
Colonic stimulants are used to promote peristalsis.
Bisacodyl (Dulcolax, Bisac Evac, Bisco-Lax)
Bisacodyl is a colonic laxative stimulant that acts by directly stimulating colonic mucosa to produce peristalsis. It is used for relief of constipation and irregularity. This agent is available in 10-mg tablets or suppositories.
Senna (Senokot)
Senna is a natural vegetable derivative that causes neuroperistaltic stimulation. It comes in tablet or syrup form and is available in combination with docusate sodium (Senokot-S).
Hyperosmolar agents
Class Summary
Hyperosmolar agents are used for short-term treatment of constipation.
Sodium phosphate (Fleet enema)
Sodium phosphate is a purgative and laxative used in constipation and as a component of a bowel-cleansing regimen in preoperative patients.
Bulking agents
Class Summary
Bulking agents absorb water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time.
Psyllium (Metamucil, Citrucel)
Psyllium contains natural fiber that acts to increase the content of feces and, at the same time, promotes bacterial growth. Its main uses are in chronic constipation, irritable bowel syndrome, and bowel management in cases of patients with hemorrhoids.
Stool softeners
Class Summary
Stool-softening agents help keep stools soft to facilitate easy, natural passage.
Docusate sodium (Colace, Surfak)
Docusate sodium is a surface-active agent used in painful anorectal conditions and cardiac conditions where maximum ease of stool passage is desired. Therevac minienema is a combination of glycerin and docusate sodium in a polyethylene glycol (PEG) base; it has been shown to produce more rapid results than a bisacodyl suppository. Docusate is available in 100-mg capsules, 20 mg/5 mL syrup, and 200 mg/5 mL microenema.
Osmotic agents
Class Summary
Osmotic agents promote bowel movement through osmotic action that holds water in the small intestine and colon.
Polyethylene glycol (PEG) solution (Miralax)
PEG solution is used for treatment of occasional constipation. In theory, there is less risk of dehydration or electrolyte imbalance with isotonic PEG than with hypertonic sugar solutions. The laxative effect is generated because PEG is not absorbed and continues to hold water by osmotic action through the small bowel and the colon, resulting in mechanical cleansing. PEG solution is supplied with a measuring cap marked to contain 17 g of laxative powder when filled to the indicated line. It may take 48-96 hours to produce bowel movement.
Opioid antagonist
Class Summary
Use of a peripherally selective opioid antagonist may be considered for treating constipation in patients who have advanced illness necessitating long-term opioid analgesia and who are unresponsive to laxatives.
Methylnaltrexone (Relistor)
Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that selectively displaces opioids from mu-opioid receptors outside the central nervous system (CNS), including those located in the gastrointestinal (GI) tract, thereby decreasing constipating effects. It is indicated for opioid-induced constipation in patients with advanced illness who are receiving palliative care when their response to laxatives has not been sufficient. Methylnaltrexone is available as a 12 mg/0.6 mL injectable solution for subcutaneous use.
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Administration of an enema.
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Illustration of neural control of gut wall by sympathetic, parasympathetic and enteric nervous system. Courtesy of Wikimedia Commons.
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Colonoscopy reveals diverticulosis (pockets within colon that can bleed or become infected). Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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Abdominal X-ray showing fecal impaction extending from pelvis upward to left subphrenic space and from left toward right flank, measuring over 40 cm in length and 33 cm in width. Image courtesy of Wikimedia Commons
