A Randomized Trial of Enema Versus Polyethylene Glycol 3350 for Fecal Disimpaction in Children Presenting to an Emergency Department

Abstract

This pilot study suggests that disimpaction by enema may be superior to PEG for immediate relief of symptoms. Larger trials are needed to assess any advantage.

Pediatric Constipation in the Emergency Department

“…Although the authors found no association between clinical response, as reported 4 to 6 weeks later, and ED treatment (7), a subsequent trial involving 79 children concluded that enema disimpaction provides superior, immediate symptom relief compared with PEG (5). In addition to causing children to become ''upset'' (5), sodium phosphate enemas have the potential to result in electrolyte abnormalities (eg, hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia, metabolic acidosis) (8). In addition to causing children to become ''upset'' (5), sodium phosphate enemas have the potential to result in electrolyte abnormalities (eg, hyperphosphatemia, hypocalcemia, hypernatremia, hypokalemia, metabolic acidosis) (8).…”

“…It has been shown to improve in >50% of children in the ED following enema administration (6,7). Other measures such as symptomatic relief following enema administration were not selected because of potential placebo effect bias and the fact that early improvements in children with constipation do not necessarily translate into long-term benefits (5). Other measures such as symptomatic relief following enema administration were not selected because of potential placebo effect bias and the fact that early improvements in children with constipation do not necessarily translate into long-term benefits (5).…”

“…Disimpaction, which is usually performed with the aid of either oral or rectal medications, or a combination of the 2, has been shown to be effective in small, uncontrolled studies (4). Although the rectal approach may be faster, it is more invasive (5). Although the rectal approach may be faster, it is more invasive (5).…”

“…Although polyethylene glycol (PEG)-based laxatives can be effectively and safely used to treat chronic constipation in children presenting for outpatient care (eg, clinics, primary care) (6), data regarding their use in children presenting for ED care are limited (5). The largest prior pediatric ED study, which included 121 children, found that only one-third of this population received an enema (7).…”

Soap Suds Enemas Are Efficacious and Safe for Treating Fecal Impaction in Children With Abdominal Pain

“…5-7 This may result in a diagnostic and therapeutic approach toward suspected constipation that varies from than algorithms used in the standard outpatient setting. Children undergoing disimpaction in the acute setting are more likely to experience pain relief in comparison to less aggressive therapies, and thus disimpaction per rectum is often employed.…”