Combined Use of Bisacodyl and Glycerin Suppositories
Yes, you can use a glycerin suppository instead of bisacodyl to avoid fissures, but using both simultaneously is not recommended and offers no clear benefit while potentially increasing rectal irritation.
Why Glycerin is the Better Choice for Your Situation
Given your history of developing anal fissures with bisacodyl alone, switching to glycerin suppositories is the safer approach rather than combining the two agents. 1
Key Reasoning:
Glycerin suppositories are explicitly recognized as safer alternatives when rectal intervention is needed, particularly for patients at risk of rectal trauma 1
Bisacodyl is contraindicated in patients with recent anal or rectal trauma, which includes active or healing fissures 1, 2
Bisacodyl causes significant local irritation, with abdominal pain/cramping occurring in 24.7% of patients (vs 2.5% with placebo) 1, 2
Why Combining Both Agents is Problematic
Using both suppositories simultaneously provides no therapeutic advantage and increases your risk of complications:
Both work through different mechanisms (bisacodyl stimulates colonic peristalsis; glycerin acts as a local osmotic agent and lubricant), but inserting both creates unnecessary mechanical trauma to already vulnerable rectal tissue 3
The combination increases the risk of rectal mucosal damage from repeated insertion 2
Bisacodyl's stimulant effect (onset 30-60 minutes) combined with glycerin's immediate lubricating action doesn't improve outcomes compared to using one agent appropriately 1, 4
Recommended Approach
Start with glycerin suppositories alone as your primary rectal intervention:
Glycerin works gently through local osmotic effect and lubrication without the harsh stimulant action that likely contributed to your fissures 1
If glycerin alone is insufficient, consider oral bisacodyl (starting at 5 mg) rather than rectal bisacodyl, as this avoids direct rectal trauma while still providing the stimulant laxative effect 5
Oral bisacodyl has lower local rectal side effects compared to suppositories, though systemic effects (diarrhea 53.4%, cramping 24.7%) still occur 1, 5
Important Caveats
Never use bisacodyl suppositories if you have active fissures or recent anal trauma - this is an absolute contraindication 1, 2
Ensure adequate hydration with any laxative regimen to prevent dehydration and electrolyte imbalances 1
If you require regular laxative use beyond occasional rescue therapy, consider osmotic laxatives (polyethylene glycol, lactulose) as first-line agents before resorting to stimulant laxatives 5, 6
Monitor for signs of worsening fissures (bleeding, severe pain with bowel movements) and seek medical attention if these occur 1