From the Guidelines
Oral Medications for Bowel Motility Post-Colostomy
Oral medications such as bisacodyl (5-10mg taken orally at bedtime) or magnesium (200 mg/day) can aid bowel motility post-colostomy, as they have been shown to induce early gastrointestinal transit after colonic resections 1.
- Bisacodyl has been demonstrated to improve postoperative intestinal function in patients undergoing colorectal surgery, with a recommended dose of 10 mg administered twice a day from the day before surgery to the third postoperative day 1.
- Magnesium has been associated with normalization of gastrointestinal transit after colonic resection, and its use in combination with other laxatives such as lactulose and metoclopramide has been advocated to support early start of normal bowel function 1.
- Alvimopan, a μ-opioid receptor antagonist, has also been shown to accelerate gastrointestinal recovery and reduce the length of stay in patients undergoing open colonic resection with postoperative opioid analgesia 1.
- Additionally, chewing gum has been found to have a positive effect on postoperative duration of ileus and can be considered as a safe and beneficial adjunct to oral laxatives 1.
The use of these medications should be individualized and monitored closely, with dose adjustments as needed to achieve the desired effect while minimizing adverse effects. It is generally recommended to start with a low dose and gradually increase as needed and tolerated. The duration of treatment will depend on the individual patient's response and the underlying cause of the delayed bowel transit.
From the FDA Drug Label
ACTIVE INGREDIENT (IN EACH DOSE) (Bottle Only) Polyethylene Glycol 3350,17 g (cap filled to line) (Packet Only) Polyethylene Glycol 3350,17 g Directions Shake well before using. Do not exceed maximum dose. Take at bedtime or as directed by a doctor.
The oral medications that aid bowel motility post-colostomy are:
- Polyethylene Glycol 3350 [@\1@]
- Senna [@\2@]
From the Research
Oral Medications for Bowel Motility Post-Colostomy
- The use of oral medications to aid bowel motility post-colostomy has been studied in various research papers 2, 3, 4, 5, 6.
- A randomized controlled trial compared a standardized postoperative laxative protocol to laxatives provided on an ad hoc basis by the surgical team, and found that the intervention group had less fecal loading and constipation 5.
- The laxative protocol used in the study included sterculia and frangula bark (Normacol Plus), a bulking agent and stimulant, and liquid paraffin (Agarol), a stool softener, as first-line treatment, and an iso-osmotic polyethylene glycol macrogel (Movicol) as second-line treatment 5.
- Another study found that dietary modifications alone relieved constipation in more than half of a group of 35 patients with constipation, and recommended a trial of dietary modifications prior to the initiation of pharmacotherapy in patients with a colostomy 6.
- The study also prescribed a psyllium-based bulk-forming agent, an osmotic stool softener, and a probiotic, with or without a prokinetic agent such as metoclopramide taken 3 times daily, for patients who did not respond to dietary changes alone 6.
- Polyethylene glycol administration has also been associated with the early return of bowel function after colorectal surgery 3.