A variety of over-the-counter preparations are available to prevent and treat constipation. These include oral medications, suppositories, and enemas. Since there are so many products available, it can be confusing to know what preparation is appropriate for your child's individual needs. To avoid this confusion your health care provider will recommend what is appropriate for your child.
Oral medications
Bulking agents
These medications help to change the consistency of the stool and make it easier to have a bowel movement. These medications expand in the intestine as fluid is absorbed. The increased "bulk" causes increased peristalsis and movement of the stool through the intestine.
Before taking these medications it is important that the bowels be cleaned out completely and that fluids are increased to prevent impaction.
Some bulking agents:
- Metamucil
- Hydrocil
- Perdiem Citrocel
- Maltsupex
Lubricants
Lubricants help soften the stool and lubricate the large intestine making it easier for the stool to pass through the bowel.
The most commonly used lubricant is mineral oil. It is easier to swallow if taken with juice. It generally produces a bowel movement in 6-8 hours. Prolonged use (over six months) can cause a deficiency in fat-soluble vitamins. Mineral oil should not be given if the child has a weak gag reflex due to the chance of aspiration.
Stimulants (laxatives)
Stimulant medications work by increasing peristalsis and moving the stool through the intestines more quickly. They can cause cramping and bowel irritation with chronic use.
Stimulant medications include Milk of Magnesia, Dulcolax tablets, and suppositories.
Stimulants should not be used on a long term basis. Continued use of stimulants decreases the natural reflex response to distention of the bowel.
Magnesium Citrate is a stimulant used for bowel cleanout. It is important that a full glass of fluid is taken with each dose of medication. Dosage can be calculated as 4cc/kg body weight twice a day. A bowel movement is generally produced within 30 minutes to six hours after taking the medication.
MiraLax® is a tasteless laxative that can be easily dissolved in water or juice.
Stool softeners
These medications increase the amount of water absorbed into the stool as it moves through the intestines. This makes the stool softer and easier to be pushed out. It is important to drink plenty of liquids when taking stool softeners. Some stool softeners are Colace and Lactulose.
Senokot is a stool softener that also has a laxative component. It is usually given at bedtime and takes 6 to 8 hours to work. It can cause cramping.
Suppositories
Suppositories are used to train the bowel to empty at a regular time. A suppository is a small bullet shaped object that is inserted in the rectum and melts from the heat of the body. They work by stimulating the nerves of the rectum to push out stool.
Types of suppositories
- Glycerin suppositories are made completely of glycerin. It irritates the rectum mechanically causing a bowel movement.
- Dulcolax suppositories contain a medicine, bisacodyl, which stimulates the bowel to empty.
- The Magic Bullet is a water base bisacodyl that melts more quickly and stimulates the bowel to contract and push out the stool more quickly than the oil based suppositories.
Enemas
Enemas are used to cleanse the bowel, relieve moderate to severe constipation and to train the bowel to empty at a regular time. There are a variety of enemas available including:
- Fleets Enemas: These are used for cleansing the bowel or relieving constipation.
- Salt Water Enemas: These are used for bowel cleanouts. A solution using two teaspoons of salt to one quart of warm water is used. Give two ounces for each year of the child's age until 8 years old. Children over eight years should get 16 ounces.
- Theravax Minienemas are small volume enemas that stimulate the bowel in 10 to 20 minutes. They are used for bowel cleanouts, daily bowel movements or part of a habit training program.
- Soap Suds Enemas are made of a small amount of castile soap and warm water. They are used primarily for bowel cleanouts.
- Enema Continence Catheter is a daily cleansing program used to achieve continence. The catheter is a tube with a balloon on the end that can be inflated in the rectum. This allows the fluid to remain in the colon. This is done on the toilet. It is useful in individuals with lax sphincter muscles and also in children having frequent stools.
Page reviewed on: Apr 29, 2009
Page reviewed by: Leslie T. McQuiston, MD