ABSTRACT
UNLABELLED: Opioid-induced constipation (OIC) is a side effect of opioid therapy that can affect quality of life, adherence to treatment, and morbidity and possibly mortality. OBJECTIVES: To investigate whether docusate sodium, sennosides, and lactulose have equal efficacy and side effect profiles compared to PEG in the management of OIC in adults. METHODS: A systematic review was undertaken. Randomized controlled trials of adults taking opioids for cancer or non-cancer pain were considered if they met inclusion criteria. CONCLUSIONS: Statistical pooling was not possible as no studies met inclusion criteria. Large, well-powered, randomized controlled trials are feasible. Standard definitions of OIC would assist with the execution of these studies and contribute to their internal and external validity. Further research is strongly encouraged.
Subject(s)
Analgesics, Opioid/adverse effects , Constipation/drug therapy , Laxatives/therapeutic use , Adult , Cathartics/adverse effects , Cathartics/pharmacology , Cathartics/therapeutic use , Constipation/chemically induced , Dioctyl Sulfosuccinic Acid/adverse effects , Dioctyl Sulfosuccinic Acid/pharmacology , Dioctyl Sulfosuccinic Acid/therapeutic use , Humans , Lactulose/adverse effects , Lactulose/pharmacology , Lactulose/therapeutic use , Laxatives/adverse effects , Laxatives/pharmacology , Polyethylene Glycols/adverse effects , Polyethylene Glycols/pharmacology , Polyethylene Glycols/therapeutic use , Senna Extract/adverse effects , Senna Extract/pharmacology , Senna Extract/therapeutic use , Surface-Active Agents/adverse effects , Surface-Active Agents/pharmacology , Surface-Active Agents/therapeutic useABSTRACT
The aim of our study was to assess the effect of oral and rectal stool softeners on dark-lumen magnetic resonance (MR) colonography without bowel cleansing. Ten volunteers underwent MR colonography without colonic cleansing. A baseline examination was performed without oral or rectal administration of stool softeners. In a second set, volunteers ingested 60 ml of lactulose 24 h prior to MR examination. In a third examination, water as a rectal enema was replaced by a solution of 0.5%-docusate sodium (DS). A fourth MR examination was performed, in conjunction with both oral administration of lactulose and rectal application of DS. A T1-weighted data set was acquired at scanning times of 0, 5 and 10 min after colonic filling. A fourth data set was acquired 75 s after i.v. injection of contrast agent. Signal intensity of stool was calculated for all colonic segments. Without oral ingestion of lactulose or rectal enema with DS stool signal intensity was high and did not decrease over time. However, lactulose and DS caused a decrease in stool signal intensity. Both substances together led to a decreasing signal intensity of feces. Combination of lactulose and DS provided the lowest signal intensity of stool. Thus, feces could hardly be distinguished from dark rectal enema allowing for the assessment of the colonic wall.
Subject(s)
Colon/diagnostic imaging , Colonography, Computed Tomographic , Dioctyl Sulfosuccinic Acid/administration & dosage , Gastrointestinal Agents/administration & dosage , Lactulose/administration & dosage , Magnetic Resonance Imaging , Surface-Active Agents/administration & dosage , Administration, Oral , Administration, Rectal , Adult , Colonography, Computed Tomographic/methods , Contrast Media/administration & dosage , Dioctyl Sulfosuccinic Acid/adverse effects , Enema , Feasibility Studies , Feces , Female , Gastrointestinal Agents/adverse effects , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Injections, Intravenous , Lactulose/adverse effects , Male , Meglumine/administration & dosage , Meglumine/analogs & derivatives , Middle Aged , Organometallic Compounds/administration & dosage , Reference Values , Surface-Active Agents/adverse effectsABSTRACT
The efficacies of four bowel care regimens (bisacodyl suppositories, glycerin suppositories, mineral oil enemas and docusate sodium mini-enemas) were compared in seven subjects with traumatic spinal cord injury. Efficacy was assessed in terms of colonic transit time, bowel evacuation time and subjective responses to a questionnaire. Both docusate sodium mini-enemas and mineral oil enemas decreased total and left-sided colonic transit time. However, docusate sodium mini-enemas were superior to mineral oil enemas in terms of the decrease in bowel evacuation time and symptom reduction. Results in this small group of subjects suggest that docusate sodium mini-enemas may have advantages in the management of bowel evacuation in individuals with spinal cord injury.