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Human rectal mucosa: proctoscopic and morphological changes caused by laxatives

J L Meisel, D Bergman, D Graney

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    Certain laxatives, like Fleet's enema and bisacodyl, significantly alter rectal mucosa appearance, potentially misleading medical professionals. Mannitol or saline enemas, however, showed no discernible effects on rectal tissues.

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    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Pathology

    Background:

    • Laxatives are commonly used, but their effects on rectal tissue morphology are not fully understood.
    • Accurate assessment of rectal mucosa is crucial for diagnosis and treatment.

    Purpose of the Study:

    • To investigate the impact of various laxatives on the proctoscopic and morphological features of the human rectum.
    • To determine if laxative-induced changes could be misinterpreted by clinicians.

    Main Methods:

    • Prospective study involving 10 healthy subjects.
    • Randomized, blinded assessment of no treatment, oral mannitol, saline enema, Fleet's Phospho-Soda enema, and bisacodyl (enema/suppository).
    • Evaluations included proctoscopy, light microscopy, scanning electron microscopy, and transmission electron microscopy.

    Main Results:

    • Mannitol-induced diarrhea and saline enemas did not alter rectal mucosa compared to controls.
    • Fleet's enema and bisacodyl caused significant proctoscopic and microscopic changes, including epithelial sloughing.
    • Bisacodyl also affected crypt epithelial cell appearance and, in some cases, led to inflammation.

    Conclusions:

    • Fleet's enema and bisacodyl can induce significant rectal mucosal changes, potentially causing misdiagnosis.
    • Medical professionals should be aware of these laxative-induced alterations when examining rectal tissues.