SHM's Clinical Quick Talks-Bowel Medications

Pdf Summary
In his document "Bowel Medications," Joseph Sweigart focuses on pain management by addressing the use of various bowel medications. Sweigart stresses that medical professionals often prescribe bowel regimens without fully understanding the treatment options available. His teaching script aims to elucidate different classes of bowel medications, create optimal prophylactic and treatment regimens, and provide actionable clinical pearls.<br /><br />Sweigart categorizes bowel medications into several classes:<br /><br />1. **Laxatives**:<br />   - Dietary Supplements: Increase fiber intake, either soluble (Benefiber, psyllium) or insoluble (whole grains, leafy greens).<br />   - Stool Softeners: Docusate (Colace) is deemed ineffective and is part of the “Things We Do for No Reason.”<br />   - Stimulants: Enhance colonic motility without affecting stool consistency (e.g., Bisacodyl, sennosides).<br />   - Osmotics: Draw fluid into the lumen, such as magnesium hydroxide, polyethylene glycol (PEG), and lactulose.<br /><br />2. **Cellular-Level Agents**:<br />   - Drugs like Lubiprostone, linaclotide, and methylnaltrexone work by increasing gut secretion or blocking gut-specific µ-opioid receptors.<br /><br />3. **Suppositories and Enemas**:<br />   - Suppositories: Inducing mild rectal irritation through agents like docusate and glycerin.<br />   - Enemas: Administering liquid to the rectum, affecting higher up the colon based on volume.<br /><br />**Prophylaxis and Treatment Regimens**:<br />- **Prophylactic Regimen**: <br />  - For patients on opioids, anticholinergics, the elderly, or fluid-restricted: Scheduled sennosides, bisacodyl, or low-volume PEG, with stronger options (MoM, PEG) as needed.<br />- **Treatment Regimen**:<br />  - For patients already constipated: Aggressively schedule sennosides or bisacodyl alongside MoM or PEG, utilizing enemas if necessary.<br /><br />**Clinical Pearls**:<br />1. Synergy among different medication classes.<br />2. PEG's adjustable dose options, from low-volume to full colon prep.<br />3. Proactive bowel management can effectively cure constipation.<br />   <br />Sweigart also suggests these medications are particularly relevant postoperatively or during acute pain syndromes and references high-value literature for further reading.
Asset Subtitle
Joseph Sweigart
Keywords
Bowel Medications
Pain Management
Laxatives
Stimulants
Osmotics
Cellular-Level Agents
Suppositories
Enemas
Prophylactic Regimen
Clinical Pearls