Clinical Study of Pediatric Chronic Constipation With Fecal Impaction

Abstract

Purpose: Disimpaction is the first step in managing pediatric chronic constipation. The aim of this study was to assess the clinical features of patients with fecal impaction and the efficacy of the regimen with rectal agents.

Methods: This was a retrospective study of 48 patients who were diagnosed as having fecal impaction among 138 patients with chronic constipation aged one year and above. Data on the characteristics of patients, symptoms and signs, treatment method, and outcome were reviewed. Glycerin enema (GE) or bisacodyl suppositories combined with oral osmotic laxative were used with informed consent on an outpatient basis. The therapeutic effect was judged after two weeks.

Results: The most common ages of first visit and onset of symptoms were two years and around one year, respectively. Ninety percent of the patients had suffered from constipation for more than a year. The most frequent symptom or sign of fecal impaction among those described in the Japanese Guideline for Pediatric Chronic Constipation was “fecal mass in rectum on imaging study” (96%), and 90% of the patients had more than two symptoms that matched those in the guideline. GE was administered in 39 patients and bisacodyl suppositories in five. Forty (90.9%) of the 44 outpatients were disimpacted successfully. Two of the four patients who were unsuccessfully disimpacted were intolerant to GE and one required manual evacuation in addition to GE.

Conclusions: The management with rectal agents, mainly GE and bisacodyl, was effective. Adequate education made most patients and parents accept it, and the success rate reached around 90%.