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Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG

Noor-L-Houda Bekkali1, Maartje-Maria van den Berg, Marcel G W Dijkgraaf

  • 1Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam, Netherlands. n.bekkali@amc.nl

Pediatrics
|December 2, 2009
PubMed

Insights

Polyethylene glycol (PEG) and enemas are equally effective for treating rectal fecal impaction in children. PEG resulted in more fecal incontinence, but both treatments showed similar improvements in colonic transit time.

Area of Science:

  • Pediatric Gastroenterology
  • Colorectal Disorders
  • Pharmacological Treatments

Background:

  • Rectal fecal impaction (RFI) is a common issue in children with functional constipation.
  • Current treatment options include enemas and osmotic laxatives like polyethylene glycol (PEG).
  • The comparative efficacy and tolerability of these treatments for RFI require further investigation.

Purpose of the Study:

  • To compare the effectiveness of enemas versus PEG in treating RFI in children.
  • To assess the impact of these treatments on colonic transit time (CTT) and patient behavior.
  • To evaluate the tolerability and side effect profiles of enemas and PEG for RFI.

Main Methods:

  • A randomized controlled trial involving children aged 4-16 with functional constipation and RFI.
  • Patients received either daily enemas or PEG (1.5 g/kg/day) for six days.
  • Assessments included successful disimpaction, defecation and incontinence frequencies, abdominal pain, watery stools, CTT measurements, and behavior questionnaires.

Main Results:

  • Both enemas (80%) and PEG (68%) achieved successful rectal disimpaction, with no statistically significant difference (P = .28).
  • PEG was associated with increased fecal incontinence and watery stools (P < .01) compared to enemas.
  • Defecation frequency, abdominal pain, and behavior scores were comparable between groups, and CTT normalized equally in both groups (P = .85).

Conclusions:

  • Enemas and PEG demonstrate equivalent efficacy in resolving rectal fecal impaction in pediatric patients.
  • PEG may lead to a higher incidence of fecal incontinence, while other outcomes and tolerability are similar.
  • Both enemas and PEG are suitable as first-line therapies for pediatric RFI.
Abstract

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