From the Guidelines
Glycerin suppositories can be used cautiously for constipation in Crohn's disease patients with a recent small bowel obstruction, but only after the obstruction has fully resolved and with a healthcare provider's approval. When considering treatment for constipation in patients with Crohn's disease and a history of small bowel obstruction, it's crucial to prioritize approaches that minimize the risk of exacerbating the condition or triggering another obstruction. According to the American Gastroenterological Association's medical position statement on constipation 1, a gradual increase in fiber intake and the use of osmotic agents like polyethylene glycol or milk of magnesia are recommended initial steps.
For patients who do not respond to these measures, the addition of a stimulant laxative, such as glycerin suppositories, may be considered. The use of glycerin suppositories is supported by the guideline, which suggests their administration 30 minutes after a meal to synergize with the gastrocolonic response 1. Key considerations for the use of glycerin suppositories in this context include:
- Starting with gentler approaches to manage constipation, such as increasing fluid intake and adding soluble fiber gradually.
- Avoiding the use of glycerin suppositories if there is active rectal inflammation, fissures, or if obstruction symptoms persist.
- Being aware that regular use of glycerin suppositories can lead to dependence.
- Recognizing that glycerin suppositories work locally in the rectum and lower colon, making them a potentially safer option than stimulant laxatives for patients with Crohn's disease, as they do not cause intestinal contractions that could worsen inflammation or trigger obstruction 1.
Given the potential risks and the importance of managing constipation effectively in patients with Crohn's disease and a history of small bowel obstruction, healthcare provider approval and monitoring are essential when considering the use of glycerin suppositories. The guideline emphasizes the importance of a tailored approach, considering the patient's specific symptoms and medical history, and potentially involving behavioral psychologists and dietitians for comprehensive management 1.
From the Research
Effectiveness of Glycerin Suppository for Constipation in Crohn's Disease Patients
- There are no research papers provided that directly assess the effectiveness of glycerin suppositories for constipation in patients with Crohn's disease and a recent small bowel obstruction.
- The provided studies focus on the management of small bowel obstructions, strictures, and other complications associated with Crohn's disease 2, 3, 4, 5.
- One study investigates the use of simethicone and polyethylene glycol to improve small bowel capsule endoscopy imaging, but it does not address the use of glycerin suppositories for constipation 6.
- The studies suggest that patients with Crohn's disease may experience constipation due to strictures, adhesions, or other complications, but they do not provide information on the effectiveness of glycerin suppositories in this context 2, 3, 4, 5.