Diagnosis of constipation depends more on quality of stools than on frequency
Treatment:
- Dietary: more free H2O, fiber, and lubricants (prune juice, olive oil, tomatoes)
- Glycerin or Dulcolax (bisacodyl) suppositories
- Fleet's enema
- Enemas of soapsuds or milk/mollases slurry
- Mineral oil 15ml PO
- MgSO4, NaSO4, MgCit, MgOH (MOM)--osmotic cathartics
- "Bulk-form" laxatives
- Stool softeners: colace (diocytl NaSulfosuccinate), maltsupex (malt soup extract)
- Senekot (senna concentrate, a direct bowel stimulant). Dose 1/2tsp BID for 1mo-1yr, 1tsp 1-5y, 2tsp 5-15y
- Tegaserod
- In a randomized trial in 1,348 adults (90% women) with chronic constipation, tegaserod 2-6mg BID vs. placebo x 12wks was ass'd with sig. higher response rates (43% vs. 25%); no rebound constipation seen during a 4-wk withdrawal period (Clin. Gastroenterol. Hepatol. 2:796, 2004--JW)
- Polyethylene glycol
- An osmotic laxative
- Not absorbed from the intestinal tract
- 68g PO may be the most effective dose
- Dose in kids = 0.8g/kg/d
- Lubiprostone (Amitiza) 24ug BID with food
- A GI motility enhancer; activates chloride chanels in GI mucosa, increasing intestinal fluid secretion
In kids 11mo-6yo with constipation, switching from cow's milk to soy milk can be effective (NEHM 339:1100, 1998--JW)
In one cohort study in 88 children (mean age 50mos) with intractible constipation (< 2 bowel movements weekly for > 3mos with no response to laxatives, enemas, or suppositories) and no h/o Hirschsprung disease, all of whom underwent spinal MRI, 9% had spinal cord abnormalities, including 6 with tethered cords. All of these children had normal neurologic examinations and no neurologic symptoms (J. Peds. 145:409, 2004--JW)