From the Guidelines
The best initial management for a 13-year-old female with autism and fecal impaction involves prompt disimpaction followed by a maintenance regimen, prioritizing methods that minimize distress and accommodate the patient's autism-related needs. When managing fecal impaction in a patient with autism, it's crucial to consider the potential for underlying medical disorders that may affect the patient's clinical presentation and response to intervention, as noted in studies such as 1. Key considerations for management include:
- Disimpaction using oral polyethylene glycol (PEG 3350) at a dose of 1-1.5 g/kg/day (maximum 100g/day) for 3-6 days, which is often better tolerated than enemas and can be less distressing for patients with autism.
- Maintenance therapy with daily PEG 3350 (0.4-0.8 g/kg/day) or other osmotic laxatives like lactulose (1-2 mL/kg/day) to prevent recurrence.
- Behavioral modifications, such as:
- Establishing a regular toileting schedule, typically after meals.
- Ensuring adequate fluid intake (1.5-2 liters daily).
- Gradually increasing dietary fiber.
- Using visual schedules to help the patient understand the toileting routine, which can be particularly helpful for individuals with autism. Given the higher rates of constipation in children with autism due to factors like restricted diets, sensory issues, and potentially reduced gut motility, consistent maintenance therapy is essential to prevent recurrence of impaction, as suggested by the need to consider medical comorbidities in ASD management 1.
From the FDA Drug Label
children 16 years of age or under: ask a doctor The FDA drug label does not answer the question.
From the Research
Initial Management Approach
The best initial management approach for a 13-year-old female with autism and fecal impaction involves a combination of disimpaction, colon evacuation, and a maintenance bowel program to prevent recurrent impactions 2.
Diagnosis and Assessment
Diagnosis begins with recognition of possible fecal impaction and confirmation by digital examination or abdominal radiography 2. The assessment of severity is best performed clinically, and further imaging may be necessary in some cases, especially when limited history is obtainable 3.
Treatment Options
Treatment options include the use of polyethylene glycol (PEG) combined with the stimulant laxative sodium picosulphate (SPS), which has been shown to be effective in removing fecalomas in children with severe constipation and impaction 4. Other options, such as other osmotic or stimulant laxatives, are also available 5.
Importance of Abdominal Radiograph
An abdominal radiograph is important in the assessment of the degree of constipation in autistic children, as clinical history may not correlate with the degree of fecal impaction 6.
Key Considerations
Key considerations in managing fecal impaction in a 13-year-old female with autism include:
- Recognizing the high prevalence of constipation in autistic children, particularly in the rectosigmoid colon, often with acquired megarectum 6
- Using a combination of medical therapy and education, including counseling families to recognize withholding behaviors and to use behavior interventions 5
- Considering referral to a subspecialist if there is concern for organic disease or if the constipation persists despite adequate therapy 5