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Monday, January 4, 2010

Constipation - Enemas or Oral Laxatives:

Constipation is a common childhood problem, which usually responds to dietary changes as well as stool softeners or laxatives. However, for some children, constipation can result in fecal impaction, which is when a hard collection of stool becomes lodged so that it cannot pass through the anus. As can be imagined, this can be extremely uncomfortable. Children often present to the pediatrician with cramping abdominal pain. If the physical exam suggests constipation and there is a positive history of constipation, an enema is often used to try to dislodge the stool and relieve the pain.

An interesting study published in the December 2009 Journal of Pediatrics tested the common practice of using enemas to relieve fecal impaction versus using an oral medication, Polyethylene Glycol-Electrolyte solution, aka PEG, which is available over the counter by the trade name Miralax. The study found that the two methods had similar success rates.

Both pediatric enemas and Miralax are available over the counter, however before diagnosing and treating your little one with severe constipation or fecal impaction it is best to consult your pediatrician to ensure that there is nothing more serious that could account for his symptoms. When discussing with your pediatrician which of the two methods, enemas or oral medication, should be tried to relieve the impaction there are many things to consider.

How quickly the treatment will work:
Enemas may work more quickly. In the study, both treatments were used for 6 consecutive days. However, the results showed that when enemas were used children usually had a bowel movement within 25 minutes. Miralax can take at least a day to start working and multiple days of treatment may be needed to fully relieve the impaction.

Ease of getting your child to take the medication:
Enemas need to be given rectally. For some children, this may prove to be difficult to administer. However, other children may refuse to take oral medications making an enema a good alternative.

Side Effects: Enemas have a higher likelihood of causing abdominal cramping until the child has a bowel movement. The cramping usually resolves within an hour. Miralax has a higher likelihood of causing fecal incontinence (uncontrollable leakage of watery stool). This may continue until the fecal impaction resolves.

Regardless of which method is used to relieve the impaction, either method should be followed by maintenance medication to prevent impaction from happening again. This medication needs to be continued for at minimum a couple of weeks to allow sufficient time for the child's bowels to return to normal. What medication and what dose should be used for maintenance should be discussed with your child's pediatrician.