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What is the Evidence for Over the Counter Laxatives to Treat Childhood Constipation?

  • Pediatric Gastroenterology (S Orenstein and S Khan, Section Editors)
  • Published:
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Abstract

Purpose of Review

Functional constipation is a common pediatric GI disorder that is responsible for a significant portion of pediatric office visits each year. It presents a significant stressor for patients, their families, and providers alike. There are a variety of over the counter agents available for treatment of pediatric constipation.

Recent Findings

Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, remain the most effective and safe therapy for both long and short term treatment of pediatric functional constipation. Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories make excellent choices for adjunct therapies in specific clinical scenarios.

Summary

There are multiple over the counter pharmacologic agents with various mechanisms of action that have demonstrated efficacy in pediatric functional constipation. These therapies are generally safe and well tolerated by patients.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Liem O, Harman J, Benninga M, Kelleher K, Mousa H, Di Lorenzo C. Healthutilization and cost impact of childhood constipation in the United States. J Pediatr. 2009;154(2):258–62. https://doi.org/10.1016/j.jpeds.2008.07.060.

    Article  PubMed  Google Scholar 

  2. van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhoodconstipation: a systematic review. Am J Gastroenterol. 2006;101(10):2401–9. https://doi.org/10.1111/j.1572-0241.2006.00771.x.

    Article  PubMed  Google Scholar 

  3. Tabbers MM, Di Lorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258–74. https://doi.org/10.1097/MPG.0000000000000266.

    Article  CAS  PubMed  Google Scholar 

  4. Koppen IJ, Nurko S, Saps M, Di Lorenzo C, Benninga MA. The pediatric Rome IV criteria: what’s new? Expert Rev Gastroenterol Hepatol. 2017;11(3):193–201. https://doi.org/10.1080/17474124.2017.1282820.

    Article  CAS  PubMed  Google Scholar 

  5. Modin L, Walsted AM, Dalby K, Jakobsen MS. Polyethylene glycolmaintenance treatment for childhood functional constipation: a randomized, placebo-controlled trial. J Pediatr Gastroenterol Nutr. 2018;67(6):732–7. https://doi.org/10.1097/MPG.0000000000002070.

    Article  CAS  PubMed  Google Scholar 

  6. Jeelani HM, Sheikh MM, Sheikh B, Mahboob H, Bharat A. Exogenous lipoidpneumonia complicated by mineral oil aspiration in a patient with chronic constipation: a case report and review. Cureus. 2020;12(7):e9294. https://doi.org/10.7759/cureus.9294.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chumpitazi CE, Henkel EB, Valdez KL, Chumpitazi BP. Soap suds enemasare efficacious and safe for treating fecal impaction in children with abdominal pain. J Pediatr Gastroenterol Nutr. 2016;63(1):15–8. https://doi.org/10.1097/MPG.0000000000001073.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Orchard JL, Lawson R. Severe colitis induced by soap enemas. South Med J. 1986;79(11):1459–60. https://doi.org/10.1097/00007611-198611000-00038.

    Article  CAS  PubMed  Google Scholar 

  9. Hansen SE, Whitehill JL, Goto CS, Quintero CA, Darling BE, Davis J. Safetyand efficacy of milk and molasses enemas compared with sodium phosphate enemas for the treatment of constipation in a pediatric emergency department. Pediatr Emerg Care. 2011;27(12):1118–20. https://doi.org/10.1097/PEC.0b013e31823b0088.

    Article  PubMed  Google Scholar 

  10. Walker M, Warner BW, Brilli RJ, Jacobs BR. Cardiopulmonary compromiseassociated with milk and molasses enema use in children. J Pediatr Gastroenterol Nutr. 2003;36(1):144–8. https://doi.org/10.1097/00005176-200301000-00028.

    Article  PubMed  Google Scholar 

  11. Librizzi J, Flores S, Morse K, Kelleher K, Carter J, Bode R. Hospital-levelvariation in practice patterns and patient outcomes for pediatric patients hospitalized with functional constipation. Hosp Pediatr. 2017;7(6):320–7. https://doi.org/10.1542/hpeds.2016-0101.

    Article  PubMed  Google Scholar 

  12. Anderson J, Furnival RA, Zhang L, et al. A comparison of the efficacy of enema solutions in pediatric emergency department patients. J Emerg Med. 2019;57(4):461–8. https://doi.org/10.1016/j.jemermed.2019.07.009.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Brady CE, DiPalma JA, Morawski SG, Santa Ana CA, Fordtran JS. Urinaryexcretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterology. 1986;90(6):1914–8. https://doi.org/10.1016/0016-5085(86)90261-1.

    Article  CAS  PubMed  Google Scholar 

  14. Hammer HF, Santa Ana CA, Schiller LR, Fordtran JS. Studies of osmoticdiarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest. 1989;84(4):1056–62. https://doi.org/10.1172/JCI114267.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Thomson MA, Jenkins HR, Bisset WM, et al. Polyethylene glycol 3350 pluselectrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study. Arch Dis Child. 2007;92(11):996–1000. https://doi.org/10.1136/adc.2006.115493.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Nurko S, Youssef NN, Sabri M, et al. PEG3350 in the treatment of childhoodconstipation: a multicenter, double-blinded, placebo-controlled trial. J Pediatr. 2008;153(2):254-261.e1. https://doi.org/10.1016/j.jpeds.2008.01.039.

    Article  CAS  PubMed  Google Scholar 

  17. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethyleneglycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001;139(3):428–32. https://doi.org/10.1067/mpd.2001.117002.

    Article  CAS  PubMed  Google Scholar 

  18. Pashankar DS, Bishop WP, Loening-Baucke V. Long-term efficacy of polyethylene glycol 3350 for the treatment of chronic constipation in children with and without encopresis. Clin Pediatr. 2003;42(9):815–9. https://doi.org/10.1177/000992280304200907.

    Article  Google Scholar 

  19. Michail S, Gendy E, Preud’Homme D, Mezoff A. Polyethylene glycol forconstipation in children younger than eighteen months old. J Pediatr Gastroenterol Nutr. 2004;39(2):197–9. https://doi.org/10.1097/00005176-200408000-00014.

    Article  CAS  PubMed  Google Scholar 

  20. Loening-Baucke V, Krishna R, Pashankar DS. Polyethylene glycol 3350 withoutelectrolytes for the treatment of functional constipation in infants and toddlers. J Pediatr Gastroenterol Nutr. 2004;39(5):536–9. https://doi.org/10.1097/00005176-200411000-00016.

    Article  CAS  PubMed  Google Scholar 

  21. Koppen IJN, van Wassenaer EA, Barendsen RW, Brand PL, Benninga MA. Adherence to polyethylene glycol treatment in children with functional constipation is associated with parental illness perceptions, satisfaction with treatment, and perceived treatment convenience. J Pediatr. 2018;199:132-139.e1. https://doi.org/10.1016/j.jpeds.2018.03.066.

    Article  PubMed  Google Scholar 

  22. •• Jarzebicka D, Sieczkowska-Golub J, Kierkus J, et al. PEG 3350 versus lactulose for treatment of functional constipation in children: randomized study. J Pediatr Gastroenterol Nutr. 2019;68(3):318–24. https://doi.org/10.1097/MPG.0000000000002192. This randomized, multicenter study showed that PEG 3350 is more effective and had fewer side effects compared to lactulose when used to treat pediatric constipation.

  23. •• Koppen IJN, Broekaert IJ, Wilschanski M, et al. Role of polyethylene glycol inthe treatment of functional constipation in children. J Pediatr Gastroenterol Nutr. 2017;65(4):361–3. https://doi.org/10.1097/MPG.0000000000001704. This citation found that overall PEG in children has been reported to be safe, although those at risk for electrolyte imbalances should have serum electrolyte monitoring.

    Article  CAS  PubMed  Google Scholar 

  24. •• Williams KC, Rogers LK, Hill I, Barnard J, Di Lorenzo C. PEG 3350 Administration is not associated with sustained elevation of glycol levels. J Pediatr. 2018;195:148-153.e1. https://doi.org/10.1016/j.jpeds.2017.11.028. This study showed that daily *PEG 3350 therapy in pediatric constipation was not associated with sustained elevation of ethylene glycol, diethylene glycol, or triethlyene glycol blood levels compared to matched controls, and that peak values of these compounds remained well below toxic levels.

    Article  CAS  PubMed  Google Scholar 

  25. Dehghani SM, Bahroloolomifard MS, Yousefi G, Pasdaran A, Hamedi A. Arandomized controlled double blinded trial to evaluate efficacy of oral administration of black strap molasses (sugarcane extract) in comparison with polyethylene glycol on pediatric functional constipation. J Ethnopharmacol. 2019;238:111845. https://doi.org/10.1016/j.jep.2019.111845.

    Article  CAS  PubMed  Google Scholar 

  26. Smith MM, Davis M, Chasalow FI, Lifshitz F. Carbohydrate absorption from fruitjuice in young children. Pediatrics. 1995;95(3):340–4.

    CAS  PubMed  Google Scholar 

  27. Loening-Baucke V, Pashankar DS. A randomized, prospective, comparisonstudy of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence. Pediatrics. 2006;118(2):528–35. https://doi.org/10.1542/peds.2006-0220.

    Article  PubMed  Google Scholar 

  28. Institute of Medicine IMUSCEDR. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington D.C.: National Academic Press; 1997.

    Google Scholar 

  29. Kutsal E, Aydemir C, Eldes N, et al. Severe hypermagnesemia as a result ofexcessive cathartic ingestion in a child without renal failure. Pediatr Emerg Care. 2007;23(8):570–2. https://doi.org/10.1097/PEC.0b013e31812eef1c.

    Article  PubMed  Google Scholar 

  30. Benninga MA, Vandenplas Y, Group MICS. The magnesium-rich formula forfunctional constipation in infants: a randomized comparator-controlled study. Pediatr Gastroenterol Hepatol Nutr. 2019;22(3):270–81. https://doi.org/10.5223/pghn.2019.22.3.270.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Usual nutrient intake from food and beverages, by gender and age, what we eat in America, NHANES 2015–2018 (2021).

  32. Mehmood MH, Siddiqi HS, Gilani AH. The antidiarrheal and spasmolyticactivities of Phyllanthus emblica are mediated through dual blockade of muscarinic receptors and Ca2+ channels. J Ethnopharmacol. 2011;133(2):856–65. https://doi.org/10.1016/j.jep.2010.11.023.

    Article  PubMed  Google Scholar 

  33. Vega AB, Perelló A, Martos L, et al. Breath methane in functional constipation: response to treatment with Ispaghula husk. Neurogastroenterol Motil. 2015;27(7):945–53. https://doi.org/10.1111/nmo.12568.

    Article  CAS  PubMed  Google Scholar 

  34. Ashraf W, Park F, Lof J, Quigley EM. Effects of psyllium therapy on stoolcharacteristics, colon transit and anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther. 1995;9(6):639–47. https://doi.org/10.1111/j.1365-2036.1995.tb00433.x.

    Article  CAS  PubMed  Google Scholar 

  35. Soltanian N, Janghorbani M. Effect of flaxseed or psyllium vs. placebo onmanagement of constipation, weight, glycemia, and lipids: a randomized trial in constipated patients with type 2 diabetes. Clin Nutr ESPEN. 2019;29:41–8. https://doi.org/10.1016/j.clnesp.2018.11.002.

    Article  PubMed  Google Scholar 

  36. Quitadamo P, Coccorullo P, Giannetti E, et al. A randomized, prospective, comparison study of a mixture of acacia fiber, psyllium fiber, and fructose vs polyethylene glycol 3350 with electrolytes for the treatment of chronic functional constipation in childhood. J Pediatr. 2012;161(4):710-5.e1. https://doi.org/10.1016/j.jpeds.2012.04.043.

    Article  CAS  PubMed  Google Scholar 

  37. Kokke FT, Scholtens PA, Alles MS, et al. A dietary fiber mixture versuslactulose in the treatment of childhood constipation: a double-blind randomized controlled trial. J Pediatr Gastroenterol Nutr. 2008;47(5):592–7. https://doi.org/10.1097/mpg.0b013e318162c43c.

    Article  CAS  PubMed  Google Scholar 

  38. Cassettari VMG, Machado NC, Lourenção PLTA, Carvalho MA, Ortolan EVP. Combinations of laxatives and green banana biomass on the treatment of functional constipation in children and adolescents: a randomized study. J Pediatr. 2019;95(1):27–33. https://doi.org/10.1016/j.jped.2017.10.011.

    Article  Google Scholar 

  39. Santucci NR, Chogle A, Mascarenhas M, et al. Non-pharmacologic approach topediatric constipation. Complement Ther Med. 2021;59:102711. https://doi.org/10.1016/j.ctim.2021.102711.

    Article  PubMed  Google Scholar 

  40. Vilanova-Sanchez A, Gasior AC, Toocheck N, et al. Are senna based laxativessafe when used as long term treatment for constipation in children? J Pediatr Surg. 2018;53(4):722–7. https://doi.org/10.1016/j.jpedsurg.2018.01.002.

  41. Bonilla S, Nurko S, Rodriguez L. Long-term use of bisacodyl in pediatric functional constipation refractory to conventional therapy. J Pediatr Gastroenterol Nutr. 2020;71(3):288–91. https://doi.org/10.1097/MPG.0000000000002795.

    Article  CAS  PubMed  Google Scholar 

  42. Tabbers MM, de Milliano I, Roseboom MG, Benninga MA. Is Bifidobacterium breve effective in the treatment of childhood constipation? Results from a pilot study. Nutr J. 2011;10:19. https://doi.org/10.1186/1475-2891-10-19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Wojtyniak K, Horvath A, Dziechciarz P, Szajewska H. Lactobacillus caseirhamnosus Lcr35 in the management of functional constipation in children: a randomized trial. J Pediatr. 2017;184:101-105.e1. https://doi.org/10.1016/j.jpeds.2017.01.068.

    Article  PubMed  Google Scholar 

  44. Jadrešin O, Sila S, Trivić I, Mišak Z, Hojsak I, Kolaček S. Lack of benefit of Lactobacillus reuteri dsm 17938 as an addition to the treatment of functional constipation. J Pediatr Gastroenterol Nutr. 2018;67(6):763–6. https://doi.org/10.1097/MPG.0000000000002134.

    Article  PubMed  Google Scholar 

  45. Kubota M, Ito K, Tomimoto K, et al. Lactobacillus reuteri DSM 17938 and magnesium oxide in children with functional chronic constipation: a double-blind and randomized clinical trial. Nutrients. 2020. https://doi.org/10.3390/nu12010225.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ladenhauf HN, Stundner O, Spreitzhofer F, Deluggi S. Severe hyperphosphatemia after administration of sodium-phosphate containing laxatives in children: case series and systematic review of literature. Pediatr Surg Int. 2012;28(8):805–14. https://doi.org/10.1007/s00383-012-3124-4.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Adam Paul

  2. Department of Pediatrics , Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Jaya Punati

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Correspondence to Adam Paul.

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Paul, A., Punati, J. What is the Evidence for Over the Counter Laxatives to Treat Childhood Constipation?. Curr Gastroenterol Rep 23, 19 (2021). https://doi.org/10.1007/s11894-021-00818-1

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