title: Disimpaction of children with severe constipation in 3-4 days in a suburban clinic using polyethylene glycol with electrolytes and sodium picosulphate.
abstract: OBJECTIVE
  Constipation is a common cause of admission to hospital for disimpaction, as oral laxatives are often inadequate. High-dose oral laxative protocols are used for complete bowel clearance prior to colonoscopy, but have not been reported for treating faecal impaction. The aim of this study was to assess the effectiveness of a high-dose oral protocol using polyethylene glycol with electrolytes (PEG + E) (Movicol Rx) combined with sodium picosulphate (SP) (Dulcolax SP Rx) in faecal impaction in children presenting to a suburban clinic.
  
  
  METHODS
  Forty-four children presented with acute/chronic faecal impaction were given six to eight sachets of PEG + E were given on day 1, with decreasing doses on subsequent 3 days, while 15-20 SP drops were given on days 2 and 3. Compliance with medication was achieved using a simple method of motivation, with the child drinking the laxatives in a race. On day 4, PEG + E was reduced to one sachet and SP to 10 drops as an ongoing maintenance dose. Defecation, soiling, diet and water intake was monitored daily for 7 days in a diary.
  
  
  RESULTS
  Forty-four children (aged 2-17 years) seen over 8 months were reviewed retrospectively. Children began defecating within 10-12 h reaching a maximum volume of stool/day (four cups) on day 2. All patients were disimpacted successfully and in the week following disimpaction there was no reported faecal soiling or complications.
  
  
  CONCLUSIONS
  A high-dose oral protocol combining PEG + E sachets and SP drops successfully and safely disimpacted a cohort of children with acute/chronic constipation presenting to a suburban continence clinic. This protocol appears to be useful to control faecal disimpaction in an outpatient setting, thereby avoiding hospital admission.
authors.affiliation: Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Jordan-Ely
authors.affiliation: Urology Department, The Royal Children's Hospital, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Hutson
authors.affiliation: Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Bridget R
authors.initials: BR
authors.lastname: Southwell
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D002400:Cathartics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002951:Citrates / Q000008:administration & dosage / Q000627:therapeutic use*; D003248:Constipation / Q000188:drug therapy*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004573:Electrolytes / Q000008:administration & dosage / Q000627:therapeutic use*; D005244:Fecal Impaction / Q000188:drug therapy*; D005260:Female; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D010847:Picolines / Q000008:administration & dosage / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D012997:Solvents / Q000627:therapeutic use; D019036:Suburban Health Services; D016896:Treatment Outcome
chemical_list: D002400:Cathartics; D002951:Citrates; D004338:Drug Combinations; D004573:Electrolytes; D054368:Laxatives; D009942:Organometallic Compounds; D010847:Picolines; D012997:Solvents; D011092:Polyethylene Glycols; C005701:picosulfate sodium
keywords: constipation; disimpaction; polyethylene glycol; sodium picosulphate