Step 1: On day 1 patient takes SITZMARKS capsule by mouth with water. Instruct patient to abstain from using laxatives, enemas or suppositories of any kind for 5 days. Arrange a flat-plate abdominal X-ray on day 5 to determine the location and the extent of elimination of the radiopaque markers.
Patients who expel at least 80% (19 or more) markers have grossly normal colonic transit.
Patients who retain 6 or more markers may have follow-up abdominal X-rays within several days.
For patients whose markers accumulate in the rectosigmoid or when markers are retained diffusely, Step 2 may be warranted.
Step 2 If more than 20% (5-6 markers) are retained by day 5, instruct patient to take a bulking agent (such as KONSYL) daily for 1 to 2 weeks. Encourage liquid intake to maximize product efficacy. Instruct patient to take another SITZMARKS capsule in 1 to 2 weeks and repeat X-rays in 5 days to determine location and extent of elimination of the markers.
Reading the Results If over 80% of the markers are passed by day 5, colonic transit is grossly normal. If remaining markers are scattered about the colon, the condition is most likely hypomotilty or colonic inertia. If remaining markers are accumulated in the rectum or rectosigmoid, the condition is most likely functional outlet delay, e.g., internal rectal prolapse, anismus.