Home rectal evacuation prior to a colorectal clinic appointment: a prospective, randomized, controlled, single-blind...

The presence of faeces in the rectum can limit the effectiveness of diagnostic rigid sigmoidoscopy and therapeutic proctoscopy. This study was undertaken to determine whether home self-administration of a Microlette Micro-enema® or two glycerine suppositories improves the view on rigid sigmoidoscopy and to assess patient acceptability.

Patients referred with colorectal symptoms were prospectively randomized into three groups of 50. Patients in Groups I and II were sent a Microlette Micro-enema® or two glycerine suppositories, respectively, along with instructions for home self-administration. Group III comprised unmedicated controls.

Compliance was 98%. There was no significant difference in faecal loading between Groups I and II, but both groups had significantly more patients with empty rectums in comparison with Group III (P < 0.001). The median (interquartile range) distances in cm from the anal verge reached on rigid sigmoidoscopy in Groups I, II and III were 15.0 (15.0-20.0), 18.0 (15.0-20.0) and 15.0 (4.25-15.0), respectively (Groups I vs III and Groups II vs III P < 0.001; Groups I vs II P = 0.03). Quality of views on rigid sigmoidoscopy were best in Group II (Groups I vs III and Groups II vs III P < 0.001; Groups I vs II P = 0.04). Four patients in Group I and two in Group II found home self-administration of the enema/suppositories inconvenient or unacceptable.

Home self-administration of two glycerine suppositories prior to a colorectal clinic visit is simple, inexpensive and acceptable to patients and allows better views on rigid sigmoidoscopy.