A more recent systematic review included only these two trials, admitting that there are a number of significant limitations to the study and concluding, “Current evidence does not allow us to conclude which intervention is more effective for treating rectal faecal impaction in children with functional constipation.”⁷

Summary

Only limited data exist comparing a single enema in the ED setting versus home PEG therapy for disimpaction of children with constipation and fecal impaction. In a single pediatric emergency department study, an enema in the emergency department prior to discharge frequently demonstrated improvement in symptoms at day one, but was not superior to oral PEG home therapy at days three or five.

Dr. Jones is assistant professor of pediatric emergency medicine at the University of Kentucky in Lexington.

Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York.

References

1. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001;139(3):428-432.
2. Youssef NN, Peters JM, Henderson W, et al. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr. 2002;141(3):410-414.
3. Bekkali NL, van den Berg MM, Dijkgraaf MG, et al. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses of oral PEG. Pediatrics. 2009;124(6):e1108-1115.
4. Miller MK, Dowd MD, Friesen CA, et al. A randomized trial of enema versus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department. Pediatr Emerg Care. 2012;28(2):115-119.
5. Dziechciarz P, Wojtyniak K, Horvath A, et al. Enema versus polyethylene glycol for the management of rectal faecal impaction in children with constipation—a systematic review of randomized controlled trials. Prz Gastroenterol. 2015;10(4):234‑238.