Enemeez® was designed initially for the use in bowel training programs associated with spinal cord injuries and disease. Enemeez® is successfully used in hundreds of top VA, Model System and CARF accredited rehabilitation facilities throughout the country. By implementing Enemeez® patients will benefit by the following:

• Fast, predictable results typically in 15-20 minutes.
• Virtually eliminates episodes of incontinence, reducing complication with perianal pressure ulcers and / or wound contamination.
• No mucosal discharge, helps to maintain healthy skin integrity.
• Non-irritating formula for safe, daily long term use. No afterburn.
• Decreases risk of falls with patients due to frequent toileting and urgency voiding.
• Savings on pads, laundry, sheets, and lubricants.
• Reduce nursing / care giver intervention required for out-patient bowel care, resulting in labor cost savings.
• Reduced time spent for dressing/redressing due to episodes of incontinence or discharge.
  

PLEASE CLICK A TOPIC BELOW TO VISIT THAT SECTION:
Product Comparison
Large Volume Enemas
Constipation and Incontinence in long term care
Pressure Ulcers and the correlation to bowel care
Patient benefits to implementing Enemeez®

Product Comparison:

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Bisacodyl Clinical Facts:

• Bisacodyl provides a reproducible model of acute injury to human rectal mucosa within 30 minutes of exposure. Neutrophils persisted in the mucosa for 24 to 30 hours. These changes might be misinterpreted as a mild, acute colitis¹.
• Stimulant laxatives such as bisacodyl are not recommended for use as a regular part of a long term bowel program².
• Bisacodyl is classified as a harmful irritant. Suitable protective clothing is recommended when manufacturing³.
• Chronic use of stimulant laxatives may damage the myenteric plexus and result in colonic dysmotility⁴.
• 2/3 of all bisacodyl suppository users regularly experience mucous discharge, bleeding or an episode of incontinence⁵.

1.Gastrointestinal Endoscopy, Volume 36, No 2, 1990., 2.Northwest Regional Spinal Cord Injury System., 3. Chemblink.database of chemicals. 4. American Academy of Family Physicians, Sep 15, 1998; Constipation in the Elderly, David C. Schaefer, M.D., PhD & Lawrence J. Cheskin, M.D. 5. Alliance Laboratories In-house research.  Customer Survey Nov. 6, 2009, 1,154 Enemeez® users.

Comparison Charts: Enemeez® versus Bisacodyl products.

• Episodes of Incontinence
• Total Time for Bowel Care in Minutes.

Source:  6. Figures were extrapolated from J.G. House, MD, S.A. Stiens, MD. Pharmacologically Initiated Defecation for Persons with Spinal Cord Injury:  Effectiveness of Three Agents, Arch Phys Med Rehabil 1997;78:1062-5.

Benefits of Enemeez® over Bisacodyl products:

• Enemeez® produces no mucous discharge compared to bisacodyl users whom can experience discharge for up to four hours after use⁵.
• Enemeez® users on average save at least 228 hours on bowel care a year compared to bisacodyl users⁶.
• Bisacodyl users are twice as likely to have an episode of incontinence following a bowel care session than Enemeez® users⁶.

5. Alliance Laboratories In-house research.  Customer Survey Nov. 6, 2009, 1,154 Enemeez® users. 6. Facts were extrapolated from J.G. House, MD, S.A. Stiens, MD. Pharmacologically Initiated Defecation for Persons with Spinal Cord Injury:  Effectiveness of Three Agents, Arch Phys Med Rehabil 1997;78:1062-5.

Docusate Sodium mini-enema versus other rectal preparations:

Treatment: Each subject was studied after receiving one week of therapy with one of the following four modalities: 1) two bisacodyl suppositories, 2) two glycerin suppositories, 3) one mineral oil enema and 4) one docusate sodium mini enema (Therevac SB) daily. Outcome Measures: total colonic and segmental colonic transit times.

• The total colonic transit time was significantly reduced with evacuation, docusate sodium scored docusate sodium mini-enemas.
• There was no significant difference in total colonic between docusate sodium and mineral oil enema, and both produced significantly shorter transit times compared to bisacodyl or glycerin suppositories.
• Bowel evacuation time was least for docusate sodium mini-enemas.
• In terms of difficulty best in symptom reduction followed by, in descending order of efficacy, mineral oil enema, bisacodyl suppositories and glycerin suppositories.

7. Amir et al. 1998; USA, Downs & Black = 9, Cohort N=7Population: Age range=21-76yrs, injury level; C4-T12, 6 subjects with tetraplegia, 1 subject with paraplegia, length of injury range=2-25yrs

Large Volume Enemas:

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• Any full-size enema (such as Fleet's or tap water) is too irritating to the bowel and can cause autonomic dysreflexia. A "mini-enema", which has only a few drops of liquid stool softener, does not fall into this category and can be used regularly. Occasionally, your health care provider may prescribe a full-size enema as preparation for a medical procedure or for treatment of severe constipation².
• Enemas are meant for occasional rather than regular use. The frequent use of enemas can cause disturbances of the fluids and electrolytes in the body. This is especially true of tap water enemas⁸.

2. Northwest Regional Spinal Cord Injury System, “Taking Care of your Bowels:  Ensuring Success”. 8. http://www.medicinenet.com/constipation/page4.htm

Constipation and Incontinence in Long Term Care:

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Constipation in Long-Term Care Clinical Evidence:

• At least 75 percent of elderly hospitalized patients and nursing home residents use laxatives for bowel regulation⁹.
• Constipation affects as many as 26 percent of men and 34 percent of women over 65 years of age⁹.
• Laxatives are the most frequently prescribed drugs in Long-Term Care facilities⁴.

9. 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. 4. American Academy of Family Physicians, Sep 15, 1998; Constipation in the Elderly, David C. Schaefer, M.D., PhD & Lawrence J. Cheskin, M.D.

Incontinence in Long Term Care Clinical Evidence:

• In the nursing home setting, the prevalence of fecal incontinence approaches 50% and can be a primary cause for admission¹⁰.
• Studies show that patients placed on a regimented bowel care program receiving both oral and rectal therapies to achieve complete rectal emptying had 35% fewer episodes of fecal incontinence and 42% fewer incidents of soiled laundry¹¹.
• 46% of long term care residents experience fecal incontinence on a regular basis²¹.
• The elderlys need for frequent toileting and/or the urgency to void increases the risk of falls by as much as 26% and bone fracture by as much as 34%²³.

10. Nelson RL, Furner S. Jesudason V. Fecal Incontinence in Wisconsin nursing homes. Dis Colon Rectum. 1998;41:1226-1229. 11. Age and Ageing 2000; 29: 159-164 21. JAmMed Dir Assoc 2002; 3: 215-223 23. Saffel D. Medication in the treatment of urinary incontinence. ECPN. 2006;109:27-31

Incontinence and Pressure Ulcers

• Incontinent patients have a 22-30% higher risk of developing pressure ulcers¹²
• Odds of having a pressure ulcer were 22 times greater for adult patients with fecal incontinence¹³.
• Data highlighted that fecal incontinence can damage the skin’s integrity, leading to skin breakdown and possible wound contamination, giving rise to major healthcare costs¹⁴.
• Nursing Home residents at higher risk for developing ulcers are those who have limited ability to reposition themselves, cannot sense the need to reposition, have fecal incontinence, or cannot feed themselves¹⁵.
• Both fecal and urinary incontinence increase moisture, but fecal incontinence is hypothesized to act as a more potent risk factor for skin breakdown than urinary incontinence¹⁶.
• Fecal incontinence represents a major risk to perianal skin integrity and healing of perineal wounds (Norton, 2009). Fecal incontinence can lead to wound contamination as well as creating a challenge for practical management giving rise to major healthcare costs (Echols et al, 2007)¹⁷.
• Pressure ulcers were more prevalent (12%) among residents who had any recent bowel or bladder incontinence than among continent residents (7%)¹⁸.

12. Foxley & Baadijies, 2009 13. Maklebust&Magnan, 1994 14. Karen Ousey, Warren Gillibrand, Wounds uk, 2010, Vol 6, No 1 15. Pressure Ulcers in the Nursing Home; David M. Smith, MD; Copyright ©2004 by the American College of Physicians 16. Shannon ML, Skorga P. Pressure ulcer prevalence in two general hospitals.  Decubitus. 1989;2:38-43 17. Wounds UK, 2010, Vol 6, No 1; 86-91, Karen Ousey, Warren Gillibrand 18. 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.

Presure Ulcers and the correlation to bowel care:

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Pressure Ulcer Correlation:

• Eliminating or minimizing incontinence prevents risk to perianal skin integrity and wound contamination reducing rise in major healthcare costs¹⁷.
• No Mucosal Discharge, assisting in maintaining healthy skin integrity⁵.
• Reduced time spent sitting on a commode may reduce the risk of pelvic pressure ulcer development²⁵.

17. Wounds UK, 2010, Vol 6, No 1; 86-91, Karen Ousey, Warren Gillibrand 5. Alliance Laboratories In-house research.  Customer Survey Nov. 6, 2009, 1,154 Enemeez® users. 25. Rehabilitation Nursing (Dunn KL & Galka ML (1994) Comparison of the Effectiveness of Therevac SB and Bisacodyl Suppositories in SCI Patients Bowel Programs, Rehabil Nurs. 19 (6):334-8.

Customer benefits to implementing Enemeez®:

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• Maximize your quality of life.
• Assist in preventative care of major complications prone to customers on a bowel care program including depression, pressure ulcers, and obesity.
• Reduce episodes of incontinence.
• Fast, predictable results typically in 15-20 minutes⁵.
• Non-irritating formula for safe, long term, daily use.
• Reduce nursing intervention required for out-patient bowel care²⁵.
• Decrease risk of falls with patients due to frequent toileting and urgency voiding²³.
• Enemeez®Plus with Benzocaine to help relieve symptoms of autonomic dysreflexia.

25. Rehabilitation Nursing (Dunn KL & Galka ML (1994) Comparison of the Effectiveness of Therevac SB and Bisacodyl Suppositories in SCI Patients Bowel Programs, Rehabil Nurs. 19 (6):334-8. 5. Alliance Laboratories In-house research.  Customer Survey Nov. 6, 2009, 1,154 Enemeez® users. 23. Saffel D. Medication in the treatment of urinary incontinence. ECPN. 2006;109:27-31.v