Open AccessTreatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate
Author(s) -
Lamanna Anthony,
Dughetti Lauren D,
JordanEly Julie A,
Dobson Kyla M,
Dynan Megan,
Foo Adeline,
Kooiman Louise M P,
Murakami Naomi,
Fiuza Kaic,
Foroughi Siavash,
Leal Marcelo,
Vidmar Suzanna,
CattoSmith Anthony G,
Hutson John M,
Southwell Bridget R
Publication year - 2018
Publication title -
jgh open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.546
H-Index - 8
ISSN - 2397-9070
DOI - 10.1002/jgh3.12062
Subject(s) - fecal impaction , laxative , medicine , constipation , gastroenterology , regimen , peg ratio , chronic constipation , feces , functional constipation , surgery , paleontology , finance , economics , biology
Background and Aim Polyethylene 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. Methods Children 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. Results Eighty‐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. Conclusions A 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.