Product Information:

Active Ingredient:

Enemeez®

Delivered Active Ingredient (in each tube)
Docusate Sodium 283mg……………………………………..Stool Softener
Inactive ingredients: Glycerine and Polyethylene Glycol.

Therapeutic Efficacy:

  • Fast, predictable results typically in 2-15 minutes1, non-irritating formula. No afterburn.
  • Can reduce nursing intervention required for in-patient bowel care; can result in labor cost savings to the facility.2
  • Can assist in the improvement of patient care and FIM scores associated with bowel care.
  • Can assist in reducing time spent with patient for dressing/redressing due to episodes of incontinence or fecal discharge.2
  • Can virtually eliminate episodes of incontinence3. Can assist in reducing complications of wound contamination associated with perianal pressure ulcers.
  • No mucosal discharge3; helps to maintain healthy skin integrity.
  • Easy rectal usage for patients with reflex issues or nausea.
  • Can assist in reducing time missed in therapy/rehabilitation due to episodes of incontinence, prolonged bowel care, or fatigue.2
  • Can assist with facility savings on pads, laundry, gowns, sheets, etc. due to incontinence or fecal discharge.

Source: 1. 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. 2. Federal Register / Vol. 50, No. 10 / Tuesday, January 15, 1985 / Proposed Rules; pgs 2124-2158. 3. Alliance Laboratories In-house research. Customer Survey Nov. 6, 2009.

Clinical Pharmacokinetics:

The Enemeez® formulation functions as a hyperosmotic laxative by drawing water into the bowel from
surrounding body tissues. The docusate sodium acts as a softener by preparing the stool to readily mix with watery fluids. The increased mass of stool, promotes a bowel evacuation by stimulating nerve endings in the bowel lining and initiating peristalsis. Not only does it soften and loosen the stool but it initiates a normal stimulus. For over ten years, Enemeez® has provided the most natural replicated bowel movement of all bowel care products on the market today.

Dosage:

Enemeez®: If you have no BM in 30 minutes use Enemeez® x1, x2 or x3. Use one to three units rectally as needed or as directed by a physician. This process can be administered safely up to 3 times during a bowel care session or per day. Do not exceed physician’s recommendations. Most patients will only require one mini-enema.

Therapeutic Patient Profile:

Enemeez® is effective for bowel care needs associated with spinal cord injury and disease, multiple sclerosis, traumatic brain injury, spina bifida, long-term care, stroke and constipation. Adults and children 12 years of age and older (with adult supervision), can use one to three units daily. For children under 12 years of age, consult a physician prior to use.

Etiologies of Constipation:

Constipation in MULTIPLE SCLEROSIS Patients:
68% of those with MS experience bowel dysfunction:1

  • Approximately 1/3 of MS patients suffer from constipation.
  • Approximately 1/4 are incontinent at least once per week.
  • Constipation puts extra pressure on the urinary system and can cause bladder problems such as incontinence and UTI’s.

Source:  1. Department of Veteran Affairs—Clinical Bulletin: Bowel Management in Multiple Sclerosis,, written by Nancy J. Holland, RN, EdD, and Robin Frames. Illustrations by Russel Ball. Reviewed by the Client Education
Committee of the National MS Society’s Clinical Advisory Board.

Incontinence in LONG-TERM CARE Patients:

At least 75% of elderly hospitalized patients and nursing home residents use laxatives for bowel regulation.1
In the nursing home setting, the prevalence of fecal incontinence approaches 50% and can be a primary cause for admission.2
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 laundry.3

Source:  1. JPrimrose 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. Nelson RL, Furner S. Jesudason V. Fecal Incontinence in Wisconsin nursing homes. Dis Colon Rectum. 1998;41:1226-1229. 3. Age and Ageing 2000; 29: 159-164

Patients with a NEUROGENIC BOWEL:

  • All persons with complete SCI have neurogenic bowel. Most persons with incomplete SCI have some manifestation of bowel dysfunction.1
  • 54% of SCI patients report bowel and bladder dysfunction as a major life-limiting problem.2
  • 95% of SCI patients require at least one therapeutic procedure daily to every other day to initiate defecation.2

Source:  1. Stiens S, Bierner-Bergman S, Goetz L. Neurogenic bowel dysfunction after spinal cord injury: Clinical Evaluation and rehabilitative management. Arch Phys Med Reabil 1997;78:S86-S102. 2. Higgins PD, Johanson JF. Epidemiology of constipation in North America: A systematic review. American Journal of Gastroenterology, 2004:99:750-759.

Secondary Complications of Constipation:

Incontinence and Pressure Ulcers:

  • Incontinent patients have a 22-30% higher risk of developing pressure ulcers.1
  • Odds of having a pressure ulcer were 22 times greater for adult patients with fecal incontinence.2
  • 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 incontinence.3
  • 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).4

Source:  1. Foxley & Baadijies, 2009. 2. Maklebust&Magnan, 1994. 3. Shannon ML, Skorga P. Pressure ulcer prevalence in two general hospitals. Decubitus. 1989;2:38-43. 4. Wounds UK, 2010, Vol 6, No 1; 86-91, Karen Ousey, Warren Gillibrand

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 24-30 hours. These changes might be misinterpreted as a mild, acute colitis.1
  • 2/3 of all bisacodyl suppository users regularly experience mucosal discharge, bleeding or an episode of incontinence.2

Source:  1. Gastrointestinal Endoscopy, Volume 36, No 2, 1990. 2. Alliance Laboratories In-house research. Customer Survey Nov. 6, 2009.

Pharmacoeconomic Evaluations:

Nursing Care time and Cost Savings:

  • Staffing was identified as the major cost factor in constipation care.1
  • Administration (staffing) costs accounted for 70% of total drug costs.2
  • The total annual labor and supply cost in 2002 per long term care resident with constipation was $2,253. *Today’s cost would be substantially more.2
  • 46% of long-term care residents experience fecal incontinence on a regular basis.2
  • The mean time spent each day dealing with incontinence was 52.5 minutes per patient.2
  • The total annual cost of incontinence per patient was $16,976*.3
  • Elderly patients 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%.4

Source:  1. JAmMed Dir Assoc 2002; 3:224-228. 2. JAmMed Dir Assoc 2002; 3: 215-22. 3. *Figures were extrapolated from CAN MED ASSOC J 1992; 147 (3).Nursing wage of $31.08 for a Staff Nurse taken from 2012 Salary Survey Results from ADVANCE for Nurses. 4. Saffel D. Medication in the treatment of urinary incontinence. ECPN. 2006;109:27-31.

Pressure Ulcer Correlation and Costs:

  • Eliminating or minimizing incontinence prevents risk to perianal skin integrity and wound contamination reducing rise in major healthcare costs.1
  • No mucosal discharge, assisting in maintaining healthy skin integrity.2
  • Medicare and insurance company reimbursement policies impact the bottom line.3
  • Skin conditions were the second most frequent cause of hospitalization; mean hospitalization charges in 2009 dollars were highest for skin conditions ($75,872).4

Source:  1. Wounds UK, 2010, Vol 6, No 1; 86-91, Karen Ousey, Warren Gillibrand. 2. Alliance Laboratories In-house research. Customer survey Nov. 6, 2009. 3. Pressure Ulcer Practices Bessie Burton Sullivan Skilled Nursing Facility, Pat Borman, MD, Swedish Family Medicine, Geriatrics Fellow. 4. DeVivo & Farris, TSCIR 2011, Vol 16:53-61

Annual Cost of Incontinence & Constipation in Long-term Care facilities:

Cost Factor Annual Cost $ % of Total
Nursing Time (at $31.08/h) $4,317,414 91.8%
Laundry $ 350,000 7.5%
Disposable pads $ 35,000 0.7%
Total $4,702,414 100%

Average cost per patient* $16,976

Source: 1. *Figures were extrapolated from CAN MED ASSOC J 1992; 147 (3); Based on 177 incontinent patients. *Nursing wage of $31.08 for a Staff Nurse taken from 2012 Salary Survey Results from ADVANCE for Nurses.

Enemeez® has been Proven to Save facilities Cost in the following areas:

  • Reduced nursing intervention required for in-patient bowel care, resulting in labor cost savings to the facility.1
  • Reduced time spent sitting on a commode may reduce the risk of pelvic pressure ulcer development. Prolonged bowel care time or fatigue after bowel care interferes with a patient’s participation in therapy activities and can increase his or her length of stay.1
  • Fast, predictable results typically in 2-15 minutes.2
  • Decrease risk of falls with patients due to frequent toileting and urgency voiding.3

Source:  1. 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. 2. Federal Register / Vol. 50, No. 10 / Tuesday, January 15, 1985 / Proposed Rules; pgs 2124-2158. 3. Saffel D. Medication in the treatment of urinary incontinence. ECPN. 2006;109:27-31.

*Full copies of all studies listed in this publication can be obtained from Alliance Labs, L.L.C.

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