From the Guidelines
Bisacodyl, the active ingredient in Fleet enema, is contraindicated in individuals with ileus, intestinal obstruction, severe dehydration, or acute inflammatory conditions in the bowel. According to the most recent and highest quality study 1, bisacodyl and sodium picosulfate (SPS) are converted into the same active metabolite and act directly on the colonic mucosa to stimulate colonic peristalsis and secretion. The study highlights that bisacodyl is contraindicated in certain conditions due to the risk of adverse effects, particularly diarrhea and abdominal pain.
Some key points to consider when using bisacodyl include:
- The onset of action is typically 6–12 hours for the oral tablet, while the suppository works within 30–60 minutes 1
- The most common adverse effects for bisacodyl are diarrhea and abdominal pain, which occur in a significant proportion of patients, especially at higher doses 1
- Bisacodyl is recommended for short-term or rescue therapy due to the high incidence of side effects and the lack of long-term effectiveness studies 1
It is essential to note that Fleet enema contains bisacodyl, and its use should be guided by the contraindications and precautions outlined in the most recent clinical practice guidelines 1. Alternative options for constipation relief, such as glycerin suppositories, docusate sodium, or polyethylene glycol solutions, may be safer for patients with certain contraindications.
From the Research
Contraindications for Fleet Enema (Bisacodyl)
The following are contraindications for Fleet enema:
- Older age 2, 3, 4
- Bowel obstruction 2
- Small intestinal disorders 2
- Poor gut motility 2
- Renal disease 2, 4
- Gastrointestinal and/or renal abnormalities in children 5
Special Considerations
Fleet enema should be administered with caution in certain patients, and alternative enema preparations may be recommended to prevent fatal complications in high-risk patients 2, 3. The use of Fleet enemas has been associated with severe metabolic disorders, including hyperphosphatemia and hypocalcemia, which can be life-threatening 2, 3, 4.
Alternative Options
Low-volume polyethylene glycol with bisacodyl may be a suitable alternative for bowel preparation prior to colonoscopy, as it has been shown to be effective and have fewer adverse effects compared to 4L PEG 6.