Comparing Various Methods of Treatment for Fecal Impaction in Functional Constipation of Children

Abstract Background: Functional constipation represents the unusual passage of hard infrequent stool and or painful defecation with no obvious causes and may lead to fecal impaction. Different disimpaction methods are available including oral, rectal, and combined medications. Objectives: This study aims to compare the efficacy and effectiveness of different initial disimpaction methods and maintenance therapy for constipation. Materials and Methods: It is a prospective single-center non-blinded study. The study was conducted on 105 patients from 1 month to 14 years at pediatrics and surgery clinics at Al-Kansaa Maternity and Children Teaching Hospital from September 2021 to December 2022. The patients were randomized into seven groups manual disimpaction + phosphate enema, phosphate enema + oral lactulose, phosphate enema + polyethylene glycol (PEG), oral lactulose only, oral PEG only, bisacodyl suppositories + oral PEG, and glycerin suppositories + oral PEG. The successfully disimpacted patients were randomized into either oral lactulose or oral PEG as maintenance therapy. Results: The results revealed that the age was 5 years (66.15%) with a male-to-female ratio of 1.2:1and most of the cases were urban with moderate socioeconomic status. Approximately, 45.15% of patients had symptoms duration between 1 month and 1 year, fecal impaction with soiling was found in 34.32% of them. The highest successful disimpaction rate was in those patients receiving enema + lactulose 16 (16.8%) and the highest unsuccessful responses were in those receiving glycerin suppository followed by PEG (9.5%). Maintenance therapy with either oral PEG or lactulose shows no significant response with a P value of 1.000. Conclusion: This study concludes that phosphate enema followed by oral lactulose for 7 days was more successful in achieving disimpaction compared with other methods. The results also show that there is no significant result by using either oral lactulose or oral PEG as maintenance therapy.