The Importance of Engaging Staff Members in Improvements to Bowel Care Predictive Care Paths

This month’s webinar presentation by Lisa Pervin, PhD, RN, CRRN, reveals the importance of engaging staff to help make improvement to bowel care predictive care paths. Lisa has worked in healthcare for 35 years, and rehabilitation has been her specialty since 1979. She is a frequent presenter, and has been certified as a CRRN since 1984. The following is an overview of Lisa’s presentation.

Bowel management is a challenge in many healthcare settings, and there are several reasons why it is important to engage staff members in making improvements to patients’ bowel care programs, including the following:

• Quality of life for patients is affected
• It is a key determining factor in discharge destination
• Bowel care, if inefficient and ineffective, can increase costs and caregiver time
• Poor bowel care plans can increase patients’ risks for complications (for example, skin breakdown, pressure ulcers, nonsocomial infections and more)

One main concern outside the quality of life factor, is that fecal incontinence is common and costly in care settings. Consider the following stats:

• 46% of long term care residents experience fecal incontinence on a regular basis. [1]
• 33% of patients in the acute care setting have fecal incontinence.[2]
• The mean time spent each day dealing with incontinence is 52.5 minutes per patient.
• The total annual cost of incontinence per patient is $9,509.
• 2^nd leading cause of admission to long-term care facilities. [3]
• The cost to your organization, on average per patient, is $9,509[4]

Is your current program working?

It is important to review your bowel care programs to determine whether or not they are working.

As you know, protocols are different for different bowel diagnoses. You need to assess your patients and programs, along with your staff in order to gain an understanding of their knowledge. There are specific programs to consider as well as other considerations like the following:

• Does the patient have constipation
• Does the patient have neurogenic bowel
• Gain a clear understanding of medications and their implications (stool softeners, stimulants, suppositories, mini enemas and large volume enemas)
• Understanding and providing appropriate diet and hydration
• Implementing appropriate mobility and position

By factoring in each area of bowel care (knowledge; assessment and evaluation; planning and implementation; and program outcomes) you can work toward ongoing evaluation.

What do you need to do for ongoing evaluation?

• Accurately re-evaluate a patient’s bowel program every day
• Set long and short-term goals
• Each member of the care team should contribute feedback into a patient’s plan
• Ensure everything is clearly documented
• Implement a program evaluation and performance improvement plan

Your entire team needs to be committed to the bowel program and engaged. Each team member should:

• Be respected and feel that they matter
• Care about what happens in the workplace and to patients and coworkers
• Feel that they make a difference
• Feel that they aspire to high standards
• Feel that they are part of it

Implementing any strategy in any organization or industry requires the same thing. That strategy must be translated into the design of work throughout the organization, including:

• Clarifying key job roles and how they affect strategy
• Identifying key work processes and process redesigns that reflect the new strategy
• Identifying the appropriate outcome and process metrics (not activity metrics) and monitoring them so corrective action can be taken the moment variances occur
• Establishing clear and specific accountability for outcomes, monitoring, corrective action and change management throughout the organization, and then holding people accountable
• Building an organizational competency to manage complex projects, meaning all strategy-driven change in the organization is translated into action via a project plan that comprehensively identifies every action needed, who will do it, when and what resources they will require. Without this discipline, organizations find out too late that goals won't be met and they have no basis for diagnosing what went wrong

Benefits for Patients, Staff to Implementing Use of Enemeez in Effective Bowel Care Programs

Studies show that implementing the use of a product like Enemeez in a Bowel Care program can create a positive impact on cost savings, staff time and improved patient outcomes.

The following information is based on a recent survey conducted to determine the use of and satisfaction with Enemeez^®, a mini-enema used in managing neurogenic bowel. 177 individuals completed a written survey, which included 24 questions.

Enemeez® (Docusate Sodium Mini-Enemas) Usage:

• 84% of the respondents reported time to evacuation to be 1-20 minutes
• 45% were using Enemeez^® between 1 and just under 3 years.
• Enemeez® was used mostly once daily (42%), in the morning (58%).
• 72% reported that they had no episodes of incontinence in the past 30 days with Enemeez^®.
• Results showed considerably shorter evacuation time than other bowel care programs, which have a reported average time to evacuation of 30-75 minutes.

Products used prior to Enemeez® (Docusate Sodium Mini-Enemas):

• 39.5% used the Magic Bullet^TM (39.5%)
• 34% used bisacodyl suppository
• 32% digital stimulation.

Reported Side Effects of bisacodyl products:

• 48% experienced a mucosal discharge
• 36% had episodes of incontinence

Enemeez –Setting the standard for bowel training

[1] Figures were extrapolated from CAN MED ASSOC J 1992; 147 (3)

[2] Published online http://www.cconline.org, © 2007 American Association of Critical-Care Nurses, Crit Care Nurse 2007;27:42-46, Donna S. Driver

[3] Nelson RL, Furner S. Jesudason V. Fecal Incontinence in Wisconsin nursing homes. Dis Colon Rectum. 1998;41:1226-1229. M J Borrie and H A Davidson. CMAJ. 1992 August 1; 147(3): 322–328.

[4] Figures were extrapolated from CAN MED ASSOC J 1992; 147 (3); Based on 277 incontinent patients.

Education is the Solution to a Successful Bowel Care Regime

There are several issues surrounding incontinence that are often overlooked, and are important to recognize in order to have a successful bowel-care regime. When you and your patients are more educated on these issues, patients can enjoy a more productive life. Two issues include compaction and pressure ulcers.

Once common gastrointestinal issue: Fecal impaction. The incidence of fecal impaction increases with age and dramatically impairs the quality of life in the elderly.[1] One study noted that 42 percent of the patients in a particular geriatric ward had fecal incontinence.

Contributing Factors to Impaction

here are several reasons a patient may experience impaction:

• Inadequate dietary fiber intake
• Inadequate water (hydration) intake
• Lack of mobility (whether due to age or spinal cord or other injury)
• A patient’s reliance on laxatives (because of the overuse, a person is unable to produce a normal response to colonic distention, and higher doses of laxatives are needed).[2]

Symptoms and Evaluation of Impaction

• Abdominal pain and distention
• Nausea
• Vomiting
• Anorexia[3]

These symptoms result from hardened stool impacted in the rectum or distal sigmoid colon with subsequent obstruction. Additional complications such as stercoral ulceration, rectovaginal fistula, megacolon, and colonic perforation may ensue.[4]

One method to help remedy the issue is to help soften the hardened stool and simulate evacuation with enemas and suppositories, like Enemeez®.

Another issue related to bowel problems in patients: pressure ulcers.

Issues surrounding pressure ulcers: According to one study,

• patients with fecal incontinence were 22 times more likely to have pressure ulcers than patients without fecal incontinence.
• the odds of having a pressure ulcer were 37.5 times greater in patients who had both impaired mobility and fecal incontinence than in patients who had neither[5]
• fecal incontinence in hospitalized patients increase the risk of nosocomial infections and the development of pressure ulcers, increases mortality, and morbidity.[6]
• the mortality rate is between 50-70% for persistent bacteremia associated with wound infected pressure ulcers.

How Can Using Enemeez® to Treat Bowel Care Issues Help Your Facility?

Studies show that implementing the use of a product like Enemeez in a successful bowel care program can create a positive impact on cost savings, staff time and improved patient outcomes. Consider the following:

A study conducted at the San Diego VA Medical Center evaluating the use of bisacodyl versus Enemeez^® formulation discovered the following:

• A pharmacoeconomic evaluation showed that patients with Enemeez ^® reduced their bowel care time by 1 hour or more daily thus reducing the time needed for a personal care attendant.
• Using Enemeez^® could result in an annual savings of more than $1,000 to the patient (based on 1994 salary rate of $6 for a personal care attendant).
• In addition, the reduced time spent sitting on a commode may reduce the risk of pelvic ulcer development. The cost to treat can be upwards of $70,000.
• Prolonged bowel care time or fatigue after bowel care interferes with a patient’s participation in therapy and can increase length of stay.

Managing bowel care independently can be difficult for anyone with a physical impairment. Patients with bowel problems often need psychological support, and information regarding how the bowel works (including an explanation of his or her specific problem). Solutions need to be tailored to each individual, and take into account the person’s abilities, lifestyle, physical environment and available help when needed.[7]

Education for the patient, and for you and your facility staff regarding treatment options, is the key to a successful bowel care program.

How Enemeez® Benefits Patients

Enemeez® products are fast acting, gentle and predictable in dealing with fecal incontinence. As compared with other products, patients do not experience a number of adverse effects.

Enemeez® can help patients reduce their episodes of incontinence and regain normal bowel function. In turn, this allows for more patient rehabilitation time and less risk of secondary complications including the effects of quality of life.

 Enemeez –Setting the standard for bowel training

Follow us on Twitter: @Enemeez

[1]De Lillo A R, Rose S. Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence. Am J Gastroenterol. 2000;95:901–905

[2]Reichel W. The Geriatric Patient. New York: HP Publishing Co; 1978. p. 78.

[3]Wrenn K. Fecal impaction. N Engl J Med. 1989;321:658–662.

[4]Schwartz J, Rabinowitz H, Rozenfeld V, Leibovitz A, Stelian J, Habot B. Rectovaginal fistula associated with fecal impaction. J Am Geriatr Soc. 1992;40:641.

[5]. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25, 27-8, 31-4 passim

[6] J. Wound Ostomy Continence Nurs. 2008; 35 (1): 104-110.

[7]Norton C, Henry M. Investigating and treatment of bowel problems. In: Fowler CJ, editor. Neurology of bladder, bowel, and sexual dysfunction. Newton, MA: Butterworth Heinemann; 1999.

Learn to Navigate the Waters: The Benefits of an Effective Bowel Care Program

To develop and manage an effective bowel care program is clearly beneficial for the patient in a number of ways. From decreased incontinence to healthier skin integrity to helping to prevent wound contamination and pressure ulcers, these are things to strive for in bowel care.

 

The Benefits an Effective Bowel Care Program for Your Facility and Staff

Not only does an effective program help your patients, but it has a great impact on your staff and your facility, too. Administrative costs play a role in the matter.

When staff care for patients who are chronically constipated or incontinent, they are spending extra time that could be spent on other patients or tasks. Constipation and incontinence alone, not to mention conditions that can develop as a result (pressure ulcers, wound care), can have financial implications, including the following:

• The cost of the medications and enemas: more than $400 million is spent in the U.S. annually on over-the-counter laxatives.[1]
• Time staff spend administering oral medications as well as enemas: the average cost per day to care for the treatment of constipation - $2.11[2]
• The number of staff interactions with a patient: the mean time spent each day dealing with incontinence - 52.5 minutes per patient.[3] Staffing costs accounted for 70 percent of total drug costs[4]
• Injuries to staff due to frequent heavy lifting of incontinent patients

Map Your Territory and Chart a Course

Of course it takes a roadmap, planned approach and evaluation process to implement an effective bowel care program for patients, whether in a long term care facility or an individual with a spinal cord injury.

To help develop a success plan, the Consortium for Spinal Cord Medicine has developed a set of guidelines, “Neurogenic Bowel Management in Adults with Spinal Cord Injury,” and recommends the following considerations when designing your program:

• Program should provide predictable and effective elimination and reduce evacuation problems and gastrointestinal complaints. Programs should be revised throughout the continuum of care.
• Within established parameters of safety and effectiveness, the design of the program should take into account attendant care, personal goals, life schedules, role obligations of the individual, and self-rated quality of life.
• Programs should be initiated during acute care and continued throughout life, unless full recovery of bowel function returns.
  • Appropriate therapies should be established based on each individual, along with consideration of appropriate fluid and diet intake, as well as activity.
  • Additional considerations: assistive techniques, medications, schedules, positioning, stimulants, triggers and diet/nutrition
• Success is not always immediate, and therefore, review of the program also needs to be considered, as appropriate.

Implement Enemeez in Your Program to Reach Success

Studies show that implementing the use of a product like Enemeez® in a bowel care program can create a positive impact on cost savings, staff time and improved patient outcomes.[1]

 

How Enemeez® Benefits Patients

Enemeez® products are fast acting, gentle and predictable in dealing with fecal incontinence. As compared with other products, patients do not experience a number of adverse effects.

Enemeez® can help patients reduce their episodes of incontinence and regain normal bowel function. In turn, this allows for more patient rehabilitation time and less risk of secondary complications including the effects of quality of life.

 

Found Benefits of Enemeez® for Bowel Care Programs:

• Reduced time needed for bowel care in patients by one hour or more daily
• Estimated results in annual cost savings in private personal care attendants by about $1,095
• Patients feel less fatigued, can participate in other activities with family, friends
• Potential reductions in pressure ulcer development in patients[2]
• Reduced injury rates in staff and patients that typically result from heavy lifting required of care for incontinent resident[1]
• Reduced episodes of incontinence[2]
• Elimination of mucosal discharge and irritation

Enemeez –Setting the standard for bowel training

Follow us on Twitter: @Enemeez

 

[1]Renee Pekmezaris, PhD; Lorraine Aversa, MA; Gisele Wolf-Klein, MD, FACP; Jesse Cedarbaum, MD; and Marie Reid-Durant, MD, “The Cost of Chronic Constipation,” Journal of American Medical Doctors Association, (July/August 2001)

2Kathleen L. Dunn, MS RN CRRN; Monique Lewis Galka, MSN RN CRRN, “A Comparison of the Effectiveness of Therevac SB™ and Bisacodyl Suppositories in SCI Patients’ Bowel Programs,” Rehabilitation Nursing, Volume 19, Number 6, (Nov/Dec 1994

3Michael J. Borrie, * MB, ChB; Heather A. Davidson,# PhD, “Incontinence in institutions: costs and contributing factors”

4Pekmezaris, Aversa, Wolf-Klein, Cedarbaum, Reid-Durant, “The Cost of Chronic Constipation,” p. 224

5 Kathleen L. Dunn, MS RN CRRN; Monique Lewis Galka, MSN RN CRRN, “A Comparison of the Effectiveness of Therevac SB™ and Bisacodyl Suppositories in SCI Patients’ Bowel Programs,” Rehabilitation Nursing, Volume 19, Number 6, (Nov/Dec 1994)

6 Dunn; Galka, “A Comparison of the Effectiveness of Therevac SB™ and Bisacodyl Suppositories in SCI Patients’ Bowel Programs,”p.338

7Carole Morgan, RN, BS, MPA; Nancy Endozoa, RN, BSN; Catherine Paradiso, RN, MS, ANP; Marion McNamara, RN, MS; Maria McGuire, RN, BSN, MPA, “Enhanced Toileting Program Decreases Incontinence in Long Term Care,” The Joint Commission Journal on Quality and Patient Safety, Volume 34, Number 4 (April 2008)

8 J. Glen House, MD, Steven A. Stiens, MD, “Pharmacologically Initiated Defecation for Persons with Spinal Cord Injury: Effectiveness of Three Agents,” Arch Phys Med Rehabil, Volume 78, (October 1997)

Neurogenic Bowel Management, Secondary Complications and Quality of Life

Neurogenic bowel, or the loss or absence of normal intestinal function, is characterized by the inability to control the elimination of stool from the body. The population of people that experience neurogenic bowel, includes those with spinal cord injury (SCI), multiple sclerosis (MS), spina bifida, TBI and even people residing in long term care facilities.
According to a recent study by clinical researcher Susan Garber, M.A., O.T.R., and a professor at Baylor College of Medicine in the Physical Medicine and Rehabilitation department, there are secondary complications and quality of life issues people with neurogenic bowel experience. People may experience many daily challenges, including those that relate to bowel management.

Challenges for People with Neurogenic Bowel:

SCI – People with complete SCI have neurogenic bowel and those with incomplete SCI have some form of bowel dysfunction. Studies show that:

§  95% of SCI patients require at least one therapeutic intervention to initiate defecation.

§  54% of SCI patients report bowel and bladder dysfunction as a major life-limiting problem.

MS – Approximately 400,000 people in the U.S. have MS, and about 2.1 million worldwide, experience this neurological disorder. Studies show that:

§  68% of people with MS experience bowel dysfunction

§  Approximately 1/3 suffer from constipation

§  Approximately 1/4 are incontinent at least once/week

§  The most common bowel problems include constipation, diarrhea and incontinence

Spina Bifida – Nerve damage in persons with spina bifida creates complications including:

§  Reduced sensation to know that your bowel is full and needs emptying, leading to bowel accidents

§  Weaker anal muscles making it more difficult for the anus to hold stools in

§  Bowel functioning that makes a person much more prone to constipation

Long Term Care Patients –

§  Constipation affects as many as 26% of men and 34% of women over the age of 65[1]

§  In the nursing home setting, the prevalence of fecal incontinence approaches 50% and can be a primary cause for admission[2]

§  Pressure ulcers were more prevalent (12%) among residents who had any recent bowel or bladder incontinence than among continent residents (7%)[3]

TBI – After a brain injury, messages from the rectum to the brain may be interrupted causing:

§  Loss of feeling for the urge to defecate

§  Loss of sphincter control, which can result in an inability to have a bowel movement

Secondary Complications

The complications involved with neurogenic bowel management include the following:

§  Time required for bowel management and the frequency of incontinence

§  Damage to the mucosa (lining of the bowel)[4]

§  Dermatitis of surrounding tissue[5]

§  Risk of pressure ulcers[6]

Fecal Incontinence is Common and Costly 

§  46% of long term care residents experience fecal incontinence on a regular basis[7]

§  33% of patients in the acute care setting have fecal incontinence[8]

§  The total annual cost of incontinence per patient is $9,509[9]

 Along with the secondary complications of neurogenic bowel, there is evidence to support that quality of life is affected for people with bowel dysfunction. This impacts barriers to personal relationships, feelings of self-worth, lower levels of satisfaction with life, including free time, friendships and family time. This poses a barrier to community integration.[10]

Results of Consumer Survey for Use of Enemeez® Mini-Enema

There are many bowel management regimens and products available that can be of help. Many hospitals, rehabilitiation centers and long-term care facilities focus on one approach that is usually based on history, costs and tradition when dealing with bowel care.

Alliance Laboratories recently conducted a consumer study to determine the use and satisfaction of Enemeez®, a mini-enema to use in bowel care programs. There were 117 respondents to the survey and included people with TBI, SCI, MS, spina bifida and other diagnosis. The following results were collected:

Enemez® (Docusate Sodium Mini-Enemas) Usage:

§  4% were using Enemeez® between 1 and just under 3 years.

§  Enemeez® was used mostly once daily (42%), in the morning (58%).

§  72% reported that they had no episodes of incontinence in the past 30 days with Enemeez®.

§  84% of the respondents reported time to evacuation to be 1-20 minutes

§  Results showed considerably shorter evacuation time than other bowel care programs, which have a reported average time to evacuation of 30-75 minutes.

Products used prior to Enemeez® (Docusate Sodium Mini-Enemas):

o   39.5% used the Magic BulletTM (39.5%)

o   34% used bisacodyl suppository

o   32% digital stimulation

 Reported Side Effects of bisacodyl products:

o   48% experienced a mucosal discharge

o   36% had episodes of incontinence

Survey Overview

The survey results indicate that, compared with other reported usual bowel care management regimens, Enemeez® substantially reduces the time to evacuation and is associated with fewer episodes of incontinence. These two findings reduce both the duration of tissue pressure exposure and damage to the skin. Also, there is no mucosal discharge associated with using Enemeez®, and these things combined can improve the quality of a person’s life and community and social integration.

How Enemeez® Benefits Patients

Enemeez® products are fast acting, gentle and predictable in dealing with fecal incontinence. As compared with other products, patients do not experience a number of adverse effects.

Enemeez® can help patients reduce their episodes of incontinence and regain normal bowel function. In turn, this allows for more patient rehabilitation time and less risk of secondary complications including the effects of quality of life.

Enemeez –Setting the standard for bowel training

---

1 Primrose WR, Capewell AE, Simpson GK, Smith RG. Prescribing patterns observed in registered nursing homes and long-stay geriatric wards. Age Ageing 1987;16:25-8. 2

2 Nelson RL, Furner S. Jesudason V. Fecal Incontinence in Wisconsin nursing homes. Dis Colon Rectum. 1998;41:1226-1229.

3 NCHS Data Brief, No. 14, February 2009. Pressure Ulcers Among Nursing Home Residents: United States, 2004 Eurice Park-Lee, PHD. and Christine Caffrey, PhD., Division of Health Care Statistics.

[4] Saunders, DR, Haggitt RC, et al. Morphological consequences of bisacodyl on normal human rectal mucosa: effect of a protaglandin E1 analog on mucosal injury. Gastrointestinal Endoscopy 1990;36:101-4.

5 Gray M. Incontinence-related skin damage: essential knowledge. Ostomy Wound Management 2007;53:28-32.

6 Luther S., Nelson, A, et al. A survey of veterans with spinal cord injury concerning outcomes related to neurogenic bowel. Abstract presented at the 2002 HSR&D Annual meeting.

7 Figures were extrapolated from CAN MED ASSOC J 1992; 147 (3).

8 Published online http://www.cconline.org, © 2007 American Association of Critical-Care Nurses, Crit Care Nurse 2007;27:42-46, Donna S. Driver

9 Figures were extrapolated from CAN MED ASSOC J 1992; 147 (3)

10 Roach MJ, Frost FS, Creasey G. social and personal consequences of acquired bowel dysfunction for persons with spinal cord injury. J Spinal Cord Med 2000;23:263-9.

Table: Consumer Survey: Use of Enemeez®

N=177
Males: 77%
Age Range: <18 - >65; 28% between 45 and 54 years
QUESTION MOST FREQUENT RESPONSE %

Duration of Enemeez® use 1 yr. - < 3 yrs. 45%
Frequency of use Once daily 42%
Time to evacuation 1-20 minutes 84%
Time of day Morning 58%

Equipment Use

Use of commode chair 54%

Modified toilet seat, etc. 26%

Diagnosis Spinal Cord Injury (N=149) 84%
Level: C5-C8 47%
T7-T12 21%
Duration: 0-4 yrs. 25%
25+ yrs. 25%
5-9 yrs. 20%
Multiple Sclerosis (N=16) 9%
Traumatic Brain Injury (N=5) 3%
Spina Bifida (N=4) 2%
Other (N=12) 7%

Assistance with bowel care
Yes 55%

Episodes of incontinence in past 30 days with Enemeez®
None 72%
1-2 Episodes 24%

Bowel management before Enemeez®
Magic Bullet™ 39.5%
Bisacodyl Suppository 34%
Digital Stimulation 32%

Side effects from Bisacodyl (N=136)
Mucosal discharge 48%
Incontinence 36%

Use of oral medications for bowel care or constipation
Yes 41%
No 38%
Sometimes 21%

Pressure ulcers
No 59%
Yes 41%

Anatomical location of ulcers
Ischial area (N=41) 23%
Sacral (N=14) 7.9%

Pressure ulcers in past 5 yrs.
None 69%
1-2 ulcers 24%
3-4 ulcers 5%

Summary of Responses to Consumer Survey Conducted by Alliance Laboratories.

The loss of voluntary control over bowel care significantly affects the quality of life of individuals with neurological impairments such as spinal cord injury, brain injury, and multiple sclerosis. There are a number of bowel management regimens and products available with varying degrees of success and patient satisfaction. Hospitals (public, private, and government), rehabilitation centers, and long-term care facilities tend to focus on a particular approach based on history, tradition, and cost. Enemeez® is a mini-enema which has been shown to improve bowel care and reduce the adverse effects of some of the other products on the market. These adverse effects include fecal incontinence (and acquired dermatitis or skin breakdown from fecal incontinence episodes), damage to the lining (mucosa) of the bowel, and the potential for the development of pressure ulcers resulting from long duration of sitting on the commode chair or toilet.

A recent survey was conducted to determine the use of and satisfaction with Enemeez®, a mini-enema used in managing neurogenic bowel. 177 individuals completed a written survey which included 24 questions. Most of the respondents (84%) had a spinal cord injury. Of these individuals, 47% had injuries at the C5-C8 level with another 21% injured at T7-T12. Duration ranged from 0-4 years (25%), 25+ years (25%) and 5-9 years (20%). Other respondents included individuals with multiple sclerosis (9%), traumatic brain injury (3%), spina bifida (2%) and other diagnoses (7%).


Most of the respondents (45%) were using Enemeez® between 1 and just under 3 years. It was used mostly once daily (42%), in the morning (58%). Of particular interest is the fact that 84% of the respondents reported time to evacuation to be 1-20 minutes, considerably shorter than other bowel care programs which have a reported average time to evacuation of 30-75 minutes. In addition, 72% reported that they had no episodes of incontinence in the past 30 days with Enemeez®.

More than half of the respondents (53%) did not have a pressure ulcer at the time of the survey. Half of the reported pressure ulcers were in the ischial area. Sixty-nine percent reported no pressure ulcers within the last 5 years.


Bowel management before Enemeez® included Magic BulletTM (39.5%), bisacodyl suppository (34%) and digital stimulation (32%). Prior bisacodyl suppository users reported side effects such as mucosal discharge (48%) and incontinence (36%).

The survey results indicate that compared with other reported usual bowel care management regimens, Enemeez® substantially reduces the time to evacuation and is associated with fewer episodes of incontinence. These two findings reduce both the duration of tissue pressure exposure and damage to the skin.


All information provided in this document is for informational purposes only. Susan L. Garber MA, OTR, FAOTA, Panel Chair of the Consortium for Spinal Cord Medicine Clinical Practice Guidelines, administrative and financial support provided by Paralyzed Veterans of America, formally reviewed the data but was not directly involved in the patient data collection. Susan L. Garber makes no representations as to the completeness, and will not be liable for any errors, omissions, arising from its display or use. All information was provided as a paid consultant of Alliance Laboratories. For more information, please consult Alliance Laboratories, 2515 E. Rose Garden Lane Suite #1, Phoenix, Arizona 85050, Ph: 888-273-9734.