Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate

Abstract

Background and AimPolyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction.MethodsChildren with symptoms for a duration of ≥2 years, a palpable fecaloma, and enlarged rectum on X‐ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X‐rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2–8 sachets (14.7 g/sachet) on days 1–2, reducing to 2–6 sachets on day 3. The SPS dose was 15–20 drops on days 2–3.ResultsEighty‐nine children (4–18 years) produced a large volume of soft stool (median/inter‐quartile‐range: 2.2/1.6–3.1 L) over 7 days. Stool volume on X‐rays decreased significantly in the colon (P < 0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal:pelvic ratios did not change.ConclusionsA combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying.

Large Bowel Obstruction Secondary to a Fecaloma in a Child With Cerebral Palsy

“…Evidence shows that auscultation of bowel sounds is not a very specific method of diagnosing bowel obstruction [ 9 ] and that clinical decisions in patients with suspected bowel obstruction should not be based on an auscultatory assessment of bowel sounds due to its low accuracy [ 10 ]. However, in this case, where the patient did not present with an abdominal mass or specific symptoms of bowel obstruction, the presence of “tinkling” or high-pitched bowel sounds prompted further investigation with an abdominal X-ray to check for bowel obstruction, which helped uncover the fecaloma and guide the management toward the immediate use of an enema to relieve the obstruction, instead of discharging the patient home on oral laxatives alone [ 11 ].…”

The ten “hard” questions in pediatric functional constipation

“…Two different studies on children with different degree of constipation evaluated a disimpaction protocol combining the highest dosage used for PEG ranged from four to eight sachets per day (13–14.7 g/sachet) and the highest sodium picosulfate dose ranged from 7.5 mg to 10 mg per day. All patients were successfully disimpacted in the first study involving 44 children with FC, while in the subsequent study recruiting children with more severe constipation, the combined treatment was effective in removing the fecaloma only in half of the children [ 73 , 74 ]. In children who fail first line disimpaction, stimulant laxatives such as senna and bisacodyl can be administered in combination with PEG [ 75 ].…”

An Update of Pharmacological Management in Children with Functional Constipation

“…Evidence for the use of sodium picosulfate for the treatment of FC in children is very scarce. Only the use of sodium picosulfate in combination with a high dose of PEG for disimpaction in children with constipation has been retrospectively studied showing promising results [ 52 , 53 ]. The highest dosage used for PEG ranged from four to eight sachets per day (13–14.7 g/sachet) and the highest sodium picosulfate dose ranged from 7.5 mg to 10 mg per day [ 52 , 53 ].…”

“…Only the use of sodium picosulfate in combination with a high dose of PEG for disimpaction in children with constipation has been retrospectively studied showing promising results [ 52 , 53 ]. The highest dosage used for PEG ranged from four to eight sachets per day (13–14.7 g/sachet) and the highest sodium picosulfate dose ranged from 7.5 mg to 10 mg per day [ 52 , 53 ]. Common adverse effects of bisacodyl and sodium picosulfate include abdominal pain, nausea, and diarrhea [ 8 ].…”