Is a glycerin enema suitable for a 10-year-old child with constipation?

Glycerin Enema for a 10-Year-Old Child with Constipation

Yes, glycerin suppositories are appropriate and recommended for a 10-year-old child with constipation that has persisted for several days. 1

Mechanism and Efficacy

Glycerin suppositories work through local irritation and by drawing water into the rectum, which softens stool and facilitates evacuation. 1 This makes them particularly useful when constipation has been present for several days and oral interventions alone have been insufficient.

When to Use Glycerin Suppositories

• Appropriate timing: Use when constipation has persisted for several days despite initial management with increased fluids, dietary fiber, and appropriate exercise. 1

• First-line rectal intervention: Glycerin suppositories are the preferred first-line rectal therapy when digital rectal examination identifies a full rectum or when oral laxatives have not been effective. 2, 1

• Can be combined: For more complete resolution, glycerin suppository may be combined with a mineral oil retention enema. 1

Important Safety Considerations

Before administering a glycerin suppository, you must ensure:

• No intestinal obstruction: Rule out symptoms of bowel obstruction including abdominal distension, absent bowel sounds, or vomiting. 1, 3

• No contraindications: Avoid rectal interventions if the child has neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis. 2, 3

• No fecal impaction requiring more aggressive treatment: If severe impaction is present, higher doses of polyethylene glycol or repeated phosphate enemas may be needed first. 4

Comparison with Other Options

Research comparing glycerin to bisacodyl suppositories in children shows that bisacodyl produces longer duration of action (40 vs 21.5 minutes), longer propagation distance, and more high amplitude propagated contractions. 5 However, glycerin remains appropriate as a first-line rectal intervention due to its safety profile and effectiveness. 1

If Constipation Persists

If the glycerin suppository does not resolve the constipation within 48-72 hours, reassess for underlying causes and consider:

• Adding bisacodyl suppository 10mg. 3
• Starting or increasing oral polyethylene glycol 17g twice daily. 3
• Adding stimulant laxatives such as senna or bisacodyl orally. 3
• Evaluating for metabolic causes including hypercalcemia, hypokalemia, hypothyroidism, or medication-related constipation. 1, 3