Treatment of Constipation
Type of Therapy | Agent | Dose | Selected Adverse Effects |
|---|---|---|---|
Disimpaction | |||
Oral | 15–20 mL/year of age (maximum 240 mL/day) for 3 days or until stool appears | Fecal incontinence, malabsorption of fat-soluble vitamins (if treatments are repeated) | |
25 mL/kg/hour (maximum 1000 mL/hour) by nasogastric tube until stool appears or 20 mL/kg/hour for 4 hours/day | Nausea, vomiting, cramping, bloating, diarrhea, fecal incontinence | ||
1–1.5 g/kg dissolved in 10 mL/kg water once/day for 3 days | Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating | ||
Rectal | Infants and older children: 1/2–1 suppository once/day for 3 days or until stool appears | None | |
2–11 years: 66 mL (one prepackaged pediatric enema) once/day for 3 days or until stool appears ≥ 12 years: 133 mL (one prepackaged adult enema) once/day for 3 days or until stool appears | Fecal incontinence, mechanical trauma | ||
Rectal phosphate sodium enema | 2– 4 years: 33 mL (one half prepackaged pediatric enema) once/day for 3 days or until stool appears 5–11 years: 66 mL (one prepackaged pediatric enema) once/day for 3 days or until stool appears ≥ 12 years: 133 mL (one prepackaged adult enema) once/day for 3 days or until stool appears | Mechanical trauma, hyperphosphatemia | |
Maintenance agents | |||
Oral osmotic and lubricant laxatives | 1 mL/kg 1 or 2 times a day (maximum 60 mL/day) | Abdominal cramping, flatus, diarrhea | |
1–2 mL/kg once/day | If overdose, risk of hypermagnesemia, hypophosphatemia, or secondary hypocalcemia | ||
< 1 year or in neurologically impaired children to avoid aspiration) | 1–3 mL/kg once/day | Fecal incontinence | |
1–18 months: 1/4 packet powder (4.25 g) in 60 mL (2 oz) water once/day > 18 months–3 years: 1/2 packet powder (8.5 g) in 120 mL (4 oz) water once/day ≥ 3 years: 1 packet (17 g) in 240 mL (8 oz) water once/day | Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating | ||
Oral stimulant laxatives (to be used for a limited period of time) | 2–11 years: 1–2 tablets once/day ≥ 12 years: 1–3 tablets once/day | Fecal incontinence, hypokalemia, abdominal cramps | |
> 1 year: 1.25 mL once/day up to 2.25 mL 2 times a day 2–5 years: 2.5 mL once/day up to 3.75 mL 2 times a day 6–11 years: 5 mL once/day up to 7.5 mL 2 times a day ≥ 12 years: 1 tablet once/day up to 2 tablets 2 times a day | Abdominal cramping, melanosis coli | ||
Maintenance diet supplements | |||
Dietary fiber supplements | < 6 years: 0.5–1 g once/day 6–11 years: 1 g 1–3 times/day ≥ 12 years: 2 g 1–3 times/day | Less bloating than other fiber supplements, cramping, flatus | |
6–11 years: 1.25–15 g 1–3 times/day ≥ 12 years: 2.5–30 g 1–3 times/day | Bloating, cramping, flatus | ||
Infants and older children: 30 to 120 mL (1–4 oz)/day | Flatus, cramping, bloating | ||
2–20 years: 5 g plus 1 g for each year of age once/day | Bloating, cramping, flatus | ||
* Numerous commercial products and preparations are available in differing concentrations, so doses are given in terms of grams of fiber. | |||