Longitudinal changes in senna-based laxative dosing in pediatric constipation: A single-center retrospective study

Chronic constipation is a common and morbid condition, especially in children with idiopathic constipation and anorectal malformations. Bowel management programs often use senna-based laxatives; however, families and providers often express concern about tolerance with long-term use. Evidence evaluating dosing changes in long-term senna use is limited.

Single-center retrospective longitudinal study including pediatric patients treated with senna-based laxatives between 2016 and 2023. Other laxatives, fecal incontinence, antegrade continence enemas, Hirschsprung disease or anorectal malformations with poor bowel control prognosis were excluded. Initial effective dose was determined at completion of bowel management week, timepoint two as the most recent follow-up. Dose was analyzed as total daily dose and mg/kg. Paired comparisons and linear mixed-effects models with patient-level random intercepts were used.

75 patients were included (mean age 8.79 ± 3.89 years; median follow-up 3.29 years). Total daily dose increased over time (median 45 mg-60 mg; p < 0.001), paralleling significant weight gain (median 21.6 kg-32.0 kg; p < 0.001). Weight-adjusted dosing was similar (median 1.89 vs. 1.88 mg/kg; p = 0.192). In mixed-effects models, patient weight was associated with dose, whereas follow-up duration was not. Timepoint was associated with increasing total daily dose but not weight-adjusted dose.

Weight-adjusted senna dose remains similar over long-term follow-up. Increases in total daily dose can be attributed to patient growth and results are not suggestive of progressive therapeutic effect loss. These findings provide no evidence of tolerance with long-term senna use and support its role in pediatric bowel management programs.