Medical Treatment for Encopresis continued...
The duration of encopresis treatment varies from child to child. Treatment should continue until the child has developed regular and reliable bowel habits and has broken the habit of holding back his or her stool. This usually takes at least several months. Generally, it takes longer in younger children than in older children.
Many parents are reluctant to give their child laxatives because they have heard that laxatives are harmful, cause more serious conditions (such as colon cancer), or promote dependency. There is no convincing evidence that any of these are true. Laxatives do not stop working if they are used every day for a long time.
Most cases of encopresis respond to the treatment regimen outlined above. If the soiling does not resolve, your child’s health care provider may refer you to a specialist in digestive and intestinal disorders (pediatric gastroenterologist), a behavioral psychologist, or both.
Medications for Encopresis
Enemas: The use of enemas for encopresis is described above. The effectiveness of any particular enema preparation is probably more dependent on the volume (size) of the enema than on its chemical make-up. The phosphate-sodium enema (Fleet Enema) is probably the most widely used type.
Note: Some gastrointestinal specialists discourage the use of enemas and suppositories or any anal intervention because the child associates fear and pain with the anal area. The child may struggle or feel additional trauma when these types of manipulations are performed. Eventually, all impacted stool can be dissolved or disimpacted by using medications taken by mouth.
Osmotic laxatives: These laxatives contain agents that are not efficiently absorbed by the intestinal lining. This results in large amounts of extra water in the intestine, which softens the stool. Since all osmotic laxatives work by increasing the amount of water in the colon, it is important that your child drinks lots of fluid while taking any of these laxatives. Like any medication, these should be given only as recommended by your child’s health care provider. If the laxative does not seem to be working, do not increase the dose without talking to your child’s health care provider. Rarely, these products interfere with other medications that your child takes.
- Magnesium hydroxide (FreeLax, Philip's Milk of Magnesia, Haley's MO) -- Besides causing retention of fluid in the intestine, this laxative promotes the release of a hormone that stimulates movement of stool through the intestine. Some children experience abdominal cramping. This laxative is flavorless but has a thick chalky texture that may be more acceptable when mixed with a fluid such as milk or chocolate milk. It should be avoided by children with kidney problems.
- Lactulose (Chronulac, Constilac, Duphalac, Kristalose) -- This laxative is generally very well tolerated and tastes sweet. It may cause gas and abdominal cramping at usual doses.
- Polyethylene glycol powder (Miralax, COLYTE, GoLYTELY) -- This may pose less risk of dehydration or electrolyte imbalance than other osmotic laxatives. The powder is mixed in 8 ounces of water, juice, soda, coffee, or tea. The usual dose is 17 grams (fill to measuring line in cap of bottle) of powder per day. This laxative is tasteless, odorless, and usually quite easy to take. It may take slightly longer to work than other products.
- Sorbitol -- This indigestible sugar tastes quite sweet. It often causes gas and abdominal cramping.
- Magnesium citrate (several generic versions, Evac-Q-mag, or Mag Citrate) -- This works by the same mechanism as magnesium hydroxide and should not be used if kidney disease is suspected. The product is clear (not chalky like magnesium hydroxide) and may be chilled to improve palatability.
- Polyethylene glycol balanced electrolyte solutions (COLYTE, GoLYTELY) -- These balanced electrolyte solutions are based on the same ingredients as Miralax, but are used to clean the colon entirely in preparation for colonoscopy or abdominal surgery. They require drinking a large volume of fluid, which may be more acceptable if chilled. This laxative may be associated with nausea, bloating, abdominal cramps, and vomiting.