Use of Dulcolax (Bisacodyl) Suppository in Patients with Chronic Anal Fistula
Bisacodyl suppositories can be used cautiously in patients with chronic anal fistula, but they are not contraindicated unless there is active infection, recent anal trauma, or severe inflammation. 1
Key Contraindications to Rectal Suppositories and Enemas
The ESMO guidelines specifically list contraindications for rectal interventions that are relevant to your decision: 1
- Recent anal or rectal trauma - contraindicated 1
- Severe colitis, inflammation or infection of the abdomen - contraindicated 1
- Recent colorectal or gynaecological surgery - contraindicated 1
- Neutropaenia or thrombocytopaenia - contraindicated 1
- Paralytic ileus or intestinal obstruction - contraindicated 1
Clinical Decision Algorithm
If the chronic anal fistula is stable and not actively infected or inflamed, bisacodyl suppositories may be used for constipation management. 1
If there is active infection, recent surgical intervention, or significant perianal inflammation, avoid suppositories and use oral laxatives instead. 1
Preferred Alternative Approach for Constipation
Rather than suppositories, oral laxatives are the safer first-line option for patients with anal fistula: 1
- Osmotic laxatives (polyethylene glycol, lactulose) - preferred option 1
- Stimulant laxatives (oral senna, sodium picosulfate) - alternative option 1
- Dietary modifications with increased fiber (25-30g daily) and adequate fluid intake 1
Important Clinical Caveat
Suppositories and enemas are only preferred first-line therapy when digital rectal examination identifies a full rectum or fecal impaction, not for routine constipation management. 1 In the context of chronic anal fistula, this creates additional risk and should prompt careful assessment before proceeding.
Bottom Line
Unless the fistula is actively infected, recently traumatized, or severely inflamed, bisacodyl suppositories are not absolutely contraindicated. However, oral laxatives represent a safer and equally effective alternative that avoids potential mechanical trauma or irritation to the fistula tract. 1