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A randomized controlled trial of enemas in combination with oral laxative therapy for children with chronic

Marloes E J Bongers1, Maartje M van den Berg, Johannes B Reitsma

  • 1Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|July 7, 2009
PubMed

Insights

For severely constipated children, adding rectal enemas to oral laxative treatment did not improve overall success rates compared to oral laxatives alone. Enemas did not offer additional benefits for children refractory to standard treatment.

Area of Science:

  • Pediatric Gastroenterology
  • Clinical Trial Research
  • Bowel Management

Background:

  • Up to 30% of children with constipation experience unsuccessful outcomes despite intensive oral laxative use.
  • Children with refractory constipation may benefit from rectal evacuation methods like enemas.
  • This study investigated enemas as an adjunct to oral laxatives in severely constipated children.

Purpose of the Study:

  • To compare the efficacy of rectal enemas combined with oral laxatives versus oral laxatives alone in treating severe functional constipation in children.
  • To evaluate the impact of additional enema therapy on defecation frequency, fecal incontinence, and overall treatment success.

Main Methods:

  • A randomized controlled trial involving 100 children (aged 8-18 years) with at least 2 years of functional constipation.
  • Participants were assigned to either a control group (oral laxatives, education, behavioral strategies) or an intervention group (same as control plus 3 rectal enemas/week, gradually reduced).
  • Outcomes, including defecation and fecal incontinence frequency and overall success, were assessed over 52 weeks.

Main Results:

  • While defecation frequency improved in both groups, it was significantly higher in the enema group at 26 and 52 weeks (P=.02).
  • No significant differences were observed in the reduction of fecal incontinence episodes (P=.49) or overall success rates (P=.67) between the groups.
  • After one year, the overall success rate was 47.1% in the intervention group versus 36.1% in the control group.

Conclusions:

  • Adding regular rectal enemas to conventional oral laxative therapy does not provide additional benefits for severely constipated children.
  • The study found no significant improvement in overall success rates or reduction in fecal incontinence with the addition of enemas.
  • Conventional oral laxative treatment alone appears to be as effective as when combined with enema maintenance therapy for this patient population.
Abstract

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