Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG.
OBJECTIVE
We hypothesized that enemas and polyethylene glycol (PEG) would be equally effective in treating rectal fecal impaction (RFI) but enemas would be less well tolerated and colonic transit time (CTT) would improve during disimpaction.


METHODS
Children (4-16 years) with functional constipation and RFI participated. One week before disimpaction, a rectal examination was performed, symptoms of constipation were recorded, and the first CTT measurement was started. If RFI was determined, then patients were assigned randomly to receive enemas once daily or PEG (1.5 g/kg per day) for 6 consecutive days. During this period, the second CTT measurement was started and a child's behavior questionnaire was administered. Successful rectal disimpaction, defecation and fecal incontinence frequencies, occurrence of abdominal pain and watery stools, CTTs (before and after disimpaction), and behavior scores were assessed.


RESULTS
Ninety-five patients were eligible, of whom 90 participated (male, n = 60; mean age: 7.5 +/- 2.8 years). Forty-six patients received enemas and 44 PEG, with 5 dropouts in each group. Successful disimpaction was achieved with enemas (80%) and PEG (68%; P = .28). Fecal incontinence and watery stools were reported more frequently with PEG (P < .01), but defecation frequency (P = .64), abdominal pain (P = .33), and behavior scores were comparable between groups. CTT normalized equally (P = .85) in the 2 groups.


CONCLUSIONS
Enemas and PEG were equally effective in treating RFI in children. Compared with enemas, PEG caused more fecal incontinence, with comparable behavior scores. The treatments should be considered equally as first-line therapy for RFI.
Bekkali
Noor-L-Houda
NL
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam, Netherlands. n.bekkali@amc.nl
van den Berg
Maartje-Maria
MM
Dijkgraaf
Marcel G W
MG
van Wijk
Michiel P
MP
Bongers
Marloes E J
ME
Liem
Olivia
O
Benninga
Marc A
MA
D000284:Administration, Oral; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000188:drug therapy*; D004143:Dioctyl Sulfosuccinic Acid / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004733:Enema; D005244:Fecal Impaction / Q000188:drug therapy*; D005242:Fecal Incontinence / Q000139:chemically induced; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome
D004143:Dioctyl Sulfosuccinic Acid; D011092:Polyethylene Glycols