# Suppositories in the Treatment of Chronic Functional Constipation



## SpAsMaN* (May 11, 2002)

http://www.medscape.com/viewarticle/509551?src=mpRole of Carbon Dioxide-Releasing Suppositories in the Treatment of Chronic Functional ConstipationA Double-Blind, Randomised, Placebo-Controlled TrialPosted 08/10/2005M. Lazzaroni; V. Casini; G. Bianchi Porro Abstract and IntroductionAbstractObjective: Treatment of chronic functional constipation is difficult. Both oral and topical laxatives may fail to adequately relieve symptoms, and there is risk of adverse effects such as functional or structural changes in the intestine, together with electrolyte disturbances. The aim of this study was to evaluate the efficacy and safety of a suppository that combines sodium bicarbonate and potassium bitartrate in a polyethylene glycol base to generate approximately 175mL of carbon dioxide (CO2). This release distends the rectal ampulla, thereby stimulating peristalsis and a subsequent bowel movement.Patients and Methods: This was a prospective, crossover, double-blind, randomised, placebo-controlled, sequential study of outpatients with chronic functional constipation. Each patient received two suppositories of identical appearance, containing active drug or placebo. The sequence of active drug-placebo (sequence 1) or placebo-active drug (sequence 2) was randomised in groups of eight. The second suppository was taken 7 days after the first. The following parameters were evaluated and scored: evacuation time, type of evacuation, feeling of emptying of the rectal ampulla, stool characteristics, anal complaints, abdominal pain and overall patient assessment.Results: A total of 29 patients entered the study. According to a restricted sequential plan, a statistical significance (p < 0.05) in favour of the active drug was reached after 26 patients. A positive response within 30 minutes of introduction of the suppository occurred in 51.7% and 6.9% of patients treated with the active drug and placebo, respectively (p = 0.0003). Normal evacuation occurred in 65.5% and 24.1% of patients treated with the active drug and placebo, respectively (p = 0.004). Normal stool consistency was found in 44.8% and 7.2% of patients treated with the active drug and placebo, respectively (p = 0.04). Patient assessment of treatment as satisfactory occurred in 51.7% and 20.7% of subjects treated with the active drug and placebo, respectively (p = 0.029). Only a trend in favour of the active drug was observed with regard to feeling of incomplete evacuation, and active drug was comparable to placebo with regard to anal and abdominal tolerabilityConclusion: The CO2-releasing suppository may represent an alternative to rectal laxatives for the relief of chronic functional constipation. The data obtained in this study indicate that CO2-releasing suppositories may be usefully and safely employed in the treatment of patients at risk for electrolyte disorders such as the elderly or patients with renal or cardiovascular disorders.IntroductionTreatment of chronic functional constipation is a difficult challenge. In more severe forms of the condition, both bulking agents and oral laxatives may fail to adequately relieve symptoms, while introducing the risk of adverse effects such as abdominal pain, functional or structural changes in the intestine (increased apoptosis of colonic epithelial cells), electrolyte disturbances and abdominal distension.[1]The combination of oral and rectal laxatives such as stimulating suppositories, hyperosmolar enemas and faecal softening agents may contribute to satisfactory emptying of the rectum by reducing straining at stool. The results are, however, unpredictable[2] and there is evidence that stimulating suppositories and hyperosmolar enemas are not as completely harmless as they have been believed to be.[3]The present investigation was carried out to evaluate the efficacy and safety of a suppository that combines sodium bicarbonate and potassium bitartrate, in a polyethylene glycol base, to generate approximately 175mL of carbon dioxide (CO2).[4,5] This release distends the rectal ampulla, thereby stimulating peristalsis and a subsequent bowel movement, usually within 30 minutes of introduction. -------------------------------------------------------------------------------- Section 1 of 5 Next Page: Patients and Methods M. Lazzaroni, V. Casini and G. Bianchi Porro, Gastrointestinal Unit, L. Sacco University Hospital, Milan, Italy


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## SpAsMaN* (May 11, 2002)

Is it this product?http://www.dulcolax.com/com/Main/Dulcolax/index.jsp


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## bonniei (Jan 25, 2001)

Ceo-Two is of that type. Look here for more info.http://www.healthtouch.com/bin/EContent_HT...osphates&cid=HTI like plain glycerin suppositories when I have incomplete evacuation.


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## bonniei (Jan 25, 2001)

Dulcolax is a stimulant(contact) laxative.Supositories containing sodium bicarbonate release carbon dioxide in the rectum and push against the walls of the intestine causing contractions which expel the stool out.


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## SpAsMaN* (May 11, 2002)

There is one coated to evoid stomack dilution,i wonder if they are irritant.


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## bonniei (Jan 25, 2001)

Suppositories do not go through the stomach. They are inserted in the rectum. So to avoid irritation suppositories would be the best.


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## SpAsMaN* (May 11, 2002)

I know Bonnei BUT here we go coated to protect the stomack:http://www.dulcolax.com/com/Main/Dulcolax/...mfort_flash.jsp


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## bonniei (Jan 25, 2001)

It is very confusing when you talk. Half the time can't tell if you are talking about dulcolax or suppositories.


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## SpAsMaN* (May 11, 2002)

Hi.







Perhaps i will try the coated pill,i find suppository quite unpleasant to take and they are often expell immediatly so i sometimes have mixed results.But i have to admit,they works very quickly.


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## SpAsMaN* (May 11, 2002)

Hi,i have one in my ass rigth now.I was ready to throw up and then i bougth the little glycerin torpedo.I hope it will clear the stomack.I took them for the children.


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## SpAsMaN* (May 11, 2002)

How long should i keep it inside Bonnei?







It start roaring in me.Gotta go...


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## SpAsMaN* (May 11, 2002)




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## SpAsMaN* (May 11, 2002)

Well it fun to feel empty when i always felt imcomplete evecuation.


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## bonniei (Jan 25, 2001)

Good to know you found relief, spasman.


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## SpAsMaN* (May 11, 2002)

B,At the moment i'm quite impress by the glycerine suppository for children to get rid of imcomplete evacuation.







No cramps,just feel "empty down there".


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## bonniei (Jan 25, 2001)

Yes they leave you with such an emptied out feeling. No ####(pun intended) stuck down there. But I would talk over with your doc regarding regular use. I use it very sparingly.


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## SpAsMaN* (May 11, 2002)

rebound effect now.


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## bonniei (Jan 25, 2001)

What do you mean by rebound effect. If you have IE every day you have to use the suppositories every day. It is time to use another one.


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## SpAsMaN* (May 11, 2002)

What is IE?I'm little more irritated due to the laxative action.Now i have trapped gas that i need to get rid.


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## bonniei (Jan 25, 2001)

IE=incomlete evacuation. Try another suppository for the trapped gas especially if you have stool in the rectum..


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## SpAsMaN* (May 11, 2002)

It works well the first day but hello the sensitivity the next day.


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## bonniei (Jan 25, 2001)

You cannot get sensitivity much higher up tan the rectum due to suppository and that too a day later. I would suggest taking another suppository. That is all I have to say about it.


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## SpAsMaN* (May 11, 2002)

In fact the head aches are worst than anything else since i'm not pain predominant.


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## SpAsMaN* (May 11, 2002)

It is possible that it is more appropriated for functional constipation like the title of the post suggest.Anyway,i don't regret it,i was in bad stomack shape yesterday.


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## bonniei (Jan 25, 2001)

headaches are not a side effect of suppositories.


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## SpAsMaN* (May 11, 2002)

I have permanent head aches,it is just aggravated by Laxatives usually one day after i took it.


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## bonniei (Jan 25, 2001)

Actually it is more likely that onstipation causes the headaches. So one day after the laxative use, the constiption is back and hence so are the headaches. You really need to try something for a period of time before making your conclusions. Otherwise it is very unscientific.


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## SpAsMaN* (May 11, 2002)

My scientific head told me that i need to get rid of sensitivity at first.


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## 20257 (Jul 25, 2005)

I have found plain glycerin suppositiories to be helpful, however I rarely have a complete evacuation with them. I also find them to be somewhat physically addictive; in the sense that if I use them three days in a row, by the second day I need two to have an evacuation at all (I use one, then after a half hour, I use another, this produces an incomplete evacuation, but sometimes i feel its my only option)I do believe that almost -any- type of laxative, stimulantn(stool softeners, colonics epsome salts, glycerin suppositories) or otherwise, loses it's effectivenes completely, or requires a dose increase and in some cases creates worse constipation in the long run. (I think mirilax is an exception from what I have understood from others from others expierance, however, it never helped me at all)


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## 21078 (Oct 1, 2005)

Just to let members know who are looking for the CEO-TWO CO2 suppositories mentioned in this thread. I called the manufacturer Beutlich Pharmaceuticals (800-238-8542) and they said that the product has not been distributed for the last 18 months due to manufacturing outsourcing problems. The rep gave me the name of a compounding pharmacy in their area (Illinois) who will make small orders by hand - Compounding Solutions - 586-991-0131 - Mike.The rep also mentioned that remaing stock is scarce, as the CO2 suppositories are very helpful for paraplegics. Dave


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## sstorm7 (Nov 15, 2000)

Has anyone tried these? How do they compare to glycerin?


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## SpAsMaN* (May 11, 2002)

> quote: Just to let members know who are looking for the CEO-TWO CO2 suppositories mentioned in this thread. I called the manufacturer Beutlich Pharmaceuticals (800-238-8542) and they said that the product has not been distributed for the last 18 months due to manufacturing outsourcing problems. The rep gave me the name of a compounding pharmacy in their area (Illinois) who will make small orders by hand - Compounding Solutions - 586-991-0131 - Mike.The rep also mentioned that remaing stock is scarce, as the CO2 suppositories are very helpful for paraplegics. Dave


Thanks Dave that is interesting but i tougth they were available OTC!!!







For those interested,there is 5 pages to read in my initial link:Here you go:http://www.medscape.com/viewarticle/509551?src=mp


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## SpAsMaN* (May 11, 2002)

bump


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