dextranomer/hyaluronate

Absorption: Provides local effect at injection site.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
rectal submucosal injection	within days	within days-months	≥12 mo

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Allergy to hyaluronic acid-based products;
Active inflammatory bowel disease;
Immunodeficiency disorders/immunosuppressant therapy;
Previous pelvic radiation;
Active anorectal abscesses, fissures, sepsis, bleeding, proctitis or other infections;
Anorectal atresia, tumors, stenosis or malformation;
Rectocele;
Rectal varices;
Existing anorectal implant.

Use Cautiously in:

Previous surgical procedures involving the anorectal region, complete anorectal disruption, significant chronic anorectal pain;
Concurrent anticoagulants or bleeding diatheses (↑ risk of bleeding following procedure);
OB: Safety and effectiveness in pregnancy not established;
Lactation: Safety and effectiveness in breastfeeding not established;
Pedi: Safety and effectiveness not established.

Adv. Reactions/Side Effects ⬆ ⬇

GI: anal fissure, anal hemorrhage, anal prolapse, anal pruritus, anorectal discomfort, constipation, defecation urgency, diarrhea, painful defecation, proctalgia, proctitis, rectal abscess, rectal discharge

GU: dyspareunia

Local: injection site hemorrhage, injection site pain

Misc: chills, fever

Interactions ⬆ ⬇

Drug-drug:

Route/Dosage ⬆ ⬇

Anorectal submucosal injection(Adults ): Four 1 mL injections: posterior, left lateral, anterior and right lateral.

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Dextranomer hyaluronate should only be administered by physicians experienced in performing anorectal procedures and having successfully completed a comprehensive training and certification program in injection procedure.
Injections are made in midline of anterior wall of rectum. Use a new needle and syringe with each injection. Hold needle at injection site for additional 15–30 sec to minimize leakage. May require repeated injections. Avoid in men with enlarged prostate.
- Do not inject IV; may cause vascular occlusion.
Pre-treatment: evacuate rectum with an enema immediately prior injection. Follow by cleansing area with antiseptic. Prophylactic antibiotics are recommended.
Patients on anticoagulant or antiplatelet therapy may experience ↑ bleeding at injection sites.

Patient/Family Teaching ⬆ ⬇

Explain purpose and procedure to patient.
Inform patient that dextranomer/hyaluronate is not effective for all patients with fecal incontinence and repeat treatment may be required for treatment effect.
Explain post-treatment care and potential adverse events to patient. Avoid physical activity for 24 hr and take prescribed or recommended analgesic as needed.
Instruct the patient to avoid taking hot baths during the 1st 24 hr posttreatment.
Stool softeners may be used until 1st bowel movement occurs; antidiarrheal drugs should not be used for 1 wk after treatment.
Advise patient to avoid sexual intercourse and strenuous activity for 1 wk, and avoid anal manipulation for 1 mo (insertion of suppositories or enemas, rectal temperature recording).
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.