Is Klisma (glycerin) suppository suitable for a 13-year-old patient with 7 days of constipation?

Glycerin Suppository for 13-Year-Old with 7 Days of Constipation

Yes, a glycerin suppository is appropriate for a 13-year-old patient with 7 days of constipation and can be safely administered to provide relief. 1

Assessment and Initial Management

• First rule out impaction, especially if there is any overflow diarrhea accompanying the constipation 1
• Check for possible obstruction through physical examination 1
• Evaluate for other potential causes of constipation such as hypercalcemia, hypokalemia, hypothyroidism, diabetes mellitus, or medications 1
• Discontinue any non-essential constipating medications if applicable 1

Treatment Approach for Adolescent Constipation

First-line interventions:

• Increase fluid intake and dietary fiber if the patient has adequate fluid intake and physical activity 1
• Encourage appropriate exercise if the patient's condition allows 1
• Ensure proper toileting habits and privacy 1

Medication management:

• Glycerin suppository is an appropriate intervention for constipation that has persisted for several days 1
• Glycerin suppositories work through local irritation and by drawing water into the rectum, softening stool and facilitating evacuation 1
• For more complete resolution, consider combining glycerin suppository with a mineral oil retention enema 1

Follow-up Management

If constipation persists after glycerin suppository:

• Reassess for cause and severity of constipation 1
• Consider adding other laxatives such as:
  • Bisacodyl suppository (one rectally daily to twice daily) 1
  • Polyethylene glycol (1 capful in 8 oz water twice daily) - shown to be more effective than other laxatives in multiple studies 1, 2
  • Lactulose (30-60 mL 2-4 times daily) 1
  • Magnesium hydroxide (30-60 mL daily to twice daily) 1

Important Considerations

• Childhood constipation responds successfully to medical therapies in approximately 70% of children within 2 years of diagnosis 3
• Aggressive early intervention is associated with better outcomes - studies show nearly 40% of constipated children remain symptomatic after 2 months of treatment when undertreated 4
• Children who undergo some form of colonic evacuation (like glycerin suppository) followed by daily laxative therapy show better response rates than those treated less aggressively 4

Cautions

• Avoid enemas in patients with neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis 1
• Ensure the patient is not experiencing symptoms of intestinal obstruction before administering the suppository 1
• If constipation persists despite appropriate therapy, consider referral to a specialist to rule out organic causes 5, 6