From the FDA Drug Label
STOP USE AND ASK A DOCTOR IF • you have rectal bleeding or your nausea, bloating, cramping or abdominal pain gets worse. These may be signs of a serious condition. The treatment for a 6-year-old with abdominal pains and X-ray findings of moderate to marked fecal loading involving the ascending, transverse, and descending colon may involve the use of polyethylene glycol (PO) or other laxatives to help clear the fecal loading. However, given the abdominal pain and potential for a serious condition, it is recommended to stop use and ask a doctor if the symptoms worsen or if rectal bleeding occurs.
- The use of docusate sodium (PO) as a stool softener may also be considered, but its effectiveness in this specific case is unclear. 1
From the Research
For a 6-year-old with abdominal pain and X-ray findings of moderate to marked fecal loading in the colon, the recommended treatment is a bowel cleanout with Polyethylene Glycol (PEG) 3350 at a dose of 1-1.5 g/kg/day divided twice daily for 3-4 days, mixed in clear liquids, as it has been shown to be more effective than lactulose in treating chronic constipation and fecal impaction 2.
Treatment Approach
The treatment approach should include:
- A bowel cleanout with PEG 3350 to address the current fecal loading
- A maintenance regimen to prevent recurrence of constipation, with a dose of 0.5-1 g/kg/day once daily
- Dietary modifications, including:
- Increased fiber intake (age plus 5-10 grams daily)
- Adequate hydration (about 1.5 liters daily)
- Regular physical activity
- Establishing a regular toileting routine, with the child sitting on the toilet for 5-10 minutes after meals to take advantage of the gastrocolic reflex
Rationale
The use of PEG 3350 is supported by studies that have shown its efficacy in treating chronic constipation and fecal impaction, with a higher success rate compared to lactulose 2, 3. Additionally, PEG 3350 has been shown to be safe and well-tolerated in children 3, 4. The comprehensive approach outlined above addresses the current fecal loading while establishing habits to prevent recurrence, and is likely to improve the child's quality of life by reducing symptoms of constipation and abdominal pain.
Additional Considerations
It is essential to note that the treatment approach may need to be adjusted based on the child's individual needs and response to treatment. Regular follow-up appointments with a healthcare provider are necessary to monitor the child's progress and make any necessary adjustments to the treatment plan.