From the Research
The latest therapy to promote bowel function after lysis of adhesions includes a multimodal approach centered on early mobilization, adequate hydration, and a stepwise medication regimen, with bisacodyl being a key component as shown in a recent review of its pharmacology and clinical evidence 1.
Key Components of Therapy
- Early mobilization to stimulate bowel motility
- Adequate hydration with 2-3 liters of fluid daily to prevent dehydration and maintain bowel function
- Stepwise medication regimen starting with oral osmotic laxatives like polyethylene glycol (MiraLAX) 17g in 8oz water once or twice daily
- Addition of a stimulant laxative such as bisacodyl (Dulcolax) 5-10mg daily if needed, which has been shown to be effective in promoting bowel function 1
- For patients with persistent constipation, addition of lubiprostone (Amitiza) 24mcg twice daily or linaclotide (Linzess) 145-290mcg once daily to activate chloride channels and increase intestinal fluid secretion and motility
Additional Considerations
- Prucalopride (Motegrity) 2mg once daily, a selective 5-HT4 receptor agonist, can be particularly effective for post-surgical ileus
- Alvimopan (Entereg) 12mg twice daily for up to 7 days may be used specifically to counter opioid-induced constipation without affecting pain control
- Adequate pain management with non-opioid alternatives when possible is crucial, as opioids significantly slow bowel motility
- Patients should be encouraged to gradually introduce fiber-rich foods as tolerated to help restore normal bowel function
Evidence Base
The use of bisacodyl in promoting bowel function is supported by a recent review of its pharmacology and clinical evidence 1, which highlights its efficacy in stimulating bowel motility and promoting regular bowel movements. Additionally, studies have shown that polyethylene glycol-based bisacodyl suppositories can reduce bowel care time and improve bowel function in patients with spinal cord injury 2, 3.