How to prescribe Microlax (bisacodyl) enema?

From the Guidelines

Microlax enema should be prescribed as a small-volume enema for relief of constipation, with one single-dose tube (5 mL) administered rectally as a one-time dose for adults and children over 3 years old, as it is a stimulant laxative that can provide quick relief for constipation 1. To prescribe it, recommend the following:

• For adults and children over 3 years old, one single-dose tube (5 mL) is administered rectally as a one-time dose.
• For children under 3 years, half a tube (2.5 mL) is typically sufficient. Instruct the patient to:
• Remove the cap from the nozzle
• Gently insert the full length of the nozzle into the rectum
• Squeeze the tube until empty The patient should remain in position for a few seconds after administration to prevent leakage. Microlax typically works within 5-15 minutes by softening the stool and stimulating bowel movements through its combination of sodium citrate (which draws water into the bowel), sodium lauryl sulfoacetate (a wetting agent), and glycerol (which lubricates) 1. Some key points to consider when prescribing Microlax enema include:
• It is for occasional use only and not for regular treatment of constipation
• If constipation persists beyond 3 days or recurs frequently, the patient should seek further medical evaluation to address the underlying cause
• The use of stimulant laxatives like Microlax is recommended for short-term use or as rescue therapy in adults with chronic idiopathic constipation, according to the American Gastroenterological Association-American College of Gastroenterology clinical practice guideline 1. It is essential to note that the prescription of Microlax enema should be based on the individual patient's needs and medical history, and patients should be advised to follow the recommended dosage and administration instructions to minimize potential side effects and ensure effective relief from constipation.

From the Research

Prescribing Microlax Enema

To prescribe Microlax enema, consider the following:

• The patient's medical history and current condition, as Microlax is relatively well tolerated 2
• The purpose of the enema, such as preparing for sigmoidoscopy or relieving constipation
• Alternative treatments, such as stimulant laxatives or manual evacuation, which may be necessary in intractable cases 2

Administration and Dosage

• Microlax enema can be self-administered by the patient before outpatient procedures, such as sigmoidoscopy 3
• The dosage and administration instructions should be clearly communicated to the patient to ensure proper use
• There is no specific information on the optimal dosage or frequency of Microlax enema in the provided studies

Efficacy and Safety

• Microlax enema has been shown to be effective in preparing the bowel for sigmoidoscopy, with an adequate view obtained in 88% of patients who received the enema 3
• The use of Microlax enema can increase the diagnostic yield and reduce the need for reattendances 3
• Common adverse events associated with laxative use include diarrhea, nausea, bloating, and abdominal pain, but no serious adverse events were reported in the studies 4

Comparison with Other Treatments

• Microlax enema contains osmotic agents, such as sorbitol, which can help relieve constipation 2
• Other treatments, such as psyllium or senna, may be more effective in certain cases, and the choice of treatment should be based on individual patient needs and medical history 5, 4