management

Last reviewed 11/2023

Do not use dietary interventions alone as first-line treatment for idiopathic constipation

Treat constipation with laxatives and a combination of:

• negotiated and non-punitive behavioural interventions suited to the child or young person's stage of development. These could include scheduled toileting and support to establish a regular bowel habit, maintenance and discussion of a bowel diary, information on constipation, and use of encouragement and rewards systems
• dietary modifications to ensure a balanced diet and sufficient fluids are consumed
• balanced diet should include:
  • adequate fluid intake
  • adequate fibre. Recommend including foods with a high fibre content (such as fruit, vegetables, high-fibre bread, baked beans and wholegrain breakfast cereals) (not applicable to exclusively breastfed infants). Do not recommend unprocessed bran, which can cause bloating and flatulence and reduce the absorption of micronutrients
• use of laxatives

Clinical management

• disimpaction
  • assess all children and young people with idiopathic constipation for faecal impaction, including children and young people who were originally referred to the relevant services because of 'red flags' but in whom there were no significant findings following further investigations
  • use a combination of history-taking and physical examination to diagnose faecal impaction - look for overflow soiling and/or faecal mass palpable abdominally and/or rectally if indicated
  • offer the following oral medication regimen for disimpaction if indicated:
    • polyethylene glycol 3350 + electrolytes e.g. Movicol, using an escalating dose regimen, as the first-line treatment
    • polyethylene glycol 3350 + electrolytes may be mixed with a cold drink
    • add a stimulant laxative e.g. Senna, if polyethylene glycol 3350 + electrolytes does not lead to disimpaction after 2 weeks
    • substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if polyethylene glycol 3350 + electrolytes is not tolerated
    • inform families that disimpaction treatment can initially increase symptoms of soiling and abdominal pain.
• start maintenance therapy if the child or young person is not faecally impacted

At the time of publication (May 2010), Movicol Paediatric Plain is the only macrogol licensed for children under 12 years that includes electrolytes. It does not have UK marketing authorisation for use in faecal impaction in children under 5 years, or for chronic constipation in children under 2 years. Informed consent should be obtained and documented. Movicol Paediatric Plain is the only macrogol licensed for children under 12 years that is also unflavoured

Reference:

• 1) NICE (May 2010). Constipation in chidren