What is the recommended dose and administration of a glycerine enema for a 5-year-old patient with constipation?

Glycerine Enema Prescription for a 5-Year-Old with Constipation

For a 5-year-old child with constipation, prescribe a single pediatric glycerin suppository (1-1.5 grams) inserted rectally as needed, rather than a glycerin enema, as this is the appropriate formulation and safer route for this age group. 1

Dosing and Administration

• Glycerin suppositories work through local rectal irritation and by drawing water into the rectum, which softens stool and facilitates evacuation 1
• Insert one pediatric glycerin suppository rectally when constipation has persisted for several days 1
• The suppository should be retained for 15-30 minutes if possible to maximize effectiveness 2
• If a single suppository is insufficient, consider combining with a mineral oil retention enema for more complete resolution 3

Critical Pre-Treatment Assessment

Before prescribing any rectal intervention, you must rule out the following contraindications:

• Perform a digital rectal examination to identify fecal impaction versus simple constipation 3
• Rule out intestinal obstruction through physical examination 2, 1
• Ensure the child does not have neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis 2, 3
• Check for undiagnosed abdominal pain, which is an absolute contraindication 2, 3

When Glycerin Suppositories Are Indicated

Glycerin suppositories are appropriate when:

• Constipation has persisted for several days despite initial conservative measures 1
• The rectum is full on digital rectal examination 2
• There is no evidence of complete fecal impaction requiring more aggressive disimpaction 3

If Constipation Persists After Suppository Use

If the glycerin suppository fails to produce a bowel movement within 24 hours, reassess for the cause and severity of constipation 1, 3:

• Consider adding oral polyethylene glycol (PEG) 1-1.5 g/kg/day for 3-6 days 4, 5
• Add bisacodyl suppository (5 mg pediatric dose) once daily if needed 3
• For true fecal impaction, escalate to either high-dose oral PEG (1.5 g/kg/day for 6 days) or daily enemas, as both are equally effective 4, 5

Common Pitfalls to Avoid

• Do not prescribe adult-sized glycerin suppositories or enemas for a 5-year-old—use pediatric formulations only 2
• Do not give oral laxatives alone if there is fecal impaction—the physical mass must be mechanically disrupted first 3
• Do not use tap water enemas initially—gentler oil retention or osmotic enemas should be used first if enemas are needed 3
• Avoid prescribing rectal interventions without first ruling out obstruction, as this can lead to perforation 2

Maintenance Therapy

After successful treatment with the glycerin suppository:

• Establish a maintenance bowel regimen to prevent recurrence, as 40-50% of children experience relapse within 5 years 6, 7
• Start daily oral laxatives such as PEG (0.4-0.8 g/kg/day) as maintenance 6
• Increase fluid intake and dietary fiber if the child has adequate oral intake 1
• Encourage appropriate toileting habits with privacy and proper positioning 1

Evidence Quality Note

The recommendation for glycerin suppositories comes from high-quality palliative care and oncology guidelines 2, 1, though these were developed for adult and adolescent populations. Pediatric research shows that for true rectal fecal impaction in children, enemas and high-dose oral PEG are equally effective (80% vs 68% success rates), but PEG causes more fecal incontinence 4. However, for simple constipation without impaction, glycerin suppositories remain the gentler first-line rectal intervention 1.