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Three Part Question

In a [child with faecal impaction] is the [oral route as effective as the rectal route] for [faecal disinpaction]?

Clinical Scenario

A ten year old child presents to the A and E department complaining of abdominal pains and not having passed a stools for two weeks. After examination you decide that he has faecal impaction. You wonder whether there would be any added benefit if a rectal enema was used instead of oral laxatives.

Search Strategy

Medline 1950- May 2007 and Embase 1980 to June 2007 using OVID interface. The Cochrane database and Cinahl was also searched.
(Exp Constipation or faec$.mp or faec$ adj impaction.mp) and (Exp Enema or enema.mp or suppository.mp or) search was limited to humans, English Language and children.

Search Outcome

166 papers were found, all of which had to be discarded as none fit the criteria of answering the question above.

Comment(s)

Using the search strategy detailed above I could not find any trials comparing outcomes when rectal enemas were used and oral cathartics were used in the treatment of faecal impaction in children. There were many trials comparing oral cathartics with rectal cathartics in children for bowel preparation before surgery or colonoscopy. However these trials could not be transferred to the above clinical scenario. It can be distressing for children to take medicine rectally and oral preparations are more commonly used. There was not enough evidence to make a decision either way in the use of rectal enemas over oral cathartics in children.

Clinical Bottom Line

Local guidelines should be followed when treating faecal impaction in children in the Emergency Department.