Pharmacological rectal stimulation:
suppositories, enemas
Rectal stimulants are used to trigger evacuation of
the bowel at the appropriate time for the individual
and are essential to achieving managed
continence for many people with neurogenic
bowel. Oral laxatives cannot replace the function
of rectal stimulants. In individuals without full
control over defaecation, use of oral laxatives
without planned stimulated reflex evacuation, or
other method of evacuation in areflexic bowel
function, often results in faecal incontinence in
individuals with neurogenic bowel dysfunction.
Suppositories of some kind are reported to be
used by between 32-71% of individuals with
neurogenic bowel dysfunction (Coggrave et al
2008, Kirk 1997, Correa and Rotter 2000).
Preserved anorectal reflexes respond to
pharmacological stimulation, which vary in the
speed and effectiveness of the evacuation they
produce (Amir et al 1998, House and Steins 1997,
Frisbie 1997, Dunn and Galka 1994). It is a
general principle to use the gentlest form of
stimulation possible in order to achieve timely
evacuation, holding more powerful stimulants in
reserve for problem-solving (Ash 2005). However
inadequate pharmacological stimulation can lead
to the requirement for more digital stimulation, so
both forms of stimulation should be considered
together when deciding on the appropriate
pharmacological stimulant for an individual.