Encopresis Medication

Updated: Oct 20, 2017
  • Author: Stephen M Borowitz, MD; Chief Editor: Carmen Cuffari, MD  more...
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Medication

Medication Summary

Because most children with encopresis have retentive encopresis as a consequence of chronic constipation with resulting overflow incontinence, therapy is initially focused on evacuating the distal colon. Disimpaction can be accomplished with aggressive use of oral cathartics or a series of enemas. After the colon is evacuated, long-term laxative therapy is generally started. Virtually any laxative can be used as long as it is used in sufficient quantity to produce 1-2 soft stools daily.

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Laxatives, Osmotic

Class Summary

Osmotic laxatives cause fluid retention in the colon, lowering the pH, resulting in distention, and increasing colonic peristalsis.

Polyethylene glycol powder (MiraLAX, GlycoLax, Gravilax)

Polyethylene glycol (PEG) 3350 consists of a long chain of ethylene glycol molecules. The resulting molecule is extremely large, is very poorly absorbed, and functions as an osmotic laxative. The powder is tasteless and odorless to most people and completely dissolves in nearly all liquids, including water. This agent can also be used as a purgative in preparation for colonoscopy. At very large dosages, PEG is occasionally difficult to take, and its use may be associated with nausea, bloating, abdominal cramps, and vomiting.

Magnesium hydroxide (Phillips' Milk of Magnesia, Dulcolax Milk of Magnesia, Pedia-Lax)

Magnesium is a divalent cation that is maximally absorbed in the distal small intestine. At low concentrations, it appears to be absorbed in a saturable carrier-mediated process influenced by vitamin D. At high concentrations, absorption appears to occur largely and inefficiently through diffusion. Increased serum magnesium levels may cause cholecystokinin release, which stimulates gastrointestinal (GI) motility and secretion; this may explain why some children have abdominal cramping.

Magnesium hydroxide formulations are mostly flavorless, with a thick and chalky texture. They are most palatable when mixed with a fluid (eg, milk or chocolate milk).

Lactulose (Kristalose, Constulose, Enulose, Generlac)

Lactulose is a synthetic nonabsorbable disaccharide that is available as a 70% solution. It is generally well tolerated and tastes sweet. Bloating, borborygmi, and flatulence are common side effects as a result of colonic flora fermenting the lactulose.

Sorbitol (Ora-Sweet SF)

Sorbitol is a hyperosmotic laxative that is available as a 70% solution. It has cathartic actions in the GI tract and is largely nonabsorbable. Sorbitol is generally well tolerated and tastes sweet. Bloating, borborygmi, and flatulence are common side effects as a result of colonic flora fermenting the sorbitol.

Magnesium citrate (Citroma)

Magnesium is a divalent cation that is maximally absorbed in the distal small intestine. At low concentrations, it appears to be absorbed in a saturable carrier-mediated process influenced by vitamin D. At high concentrations, absorption appears to occur largely and inefficiently through diffusion. Increased serum magnesium levels may cause cholecystokinin release, which stimulates gastrointestinal (GI) motility and secretion; this may explain why some children have abdominal cramping.

Magnesium citrate may be chilled to improve palatability.

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Laxative, Lubricants

Class Summary

Lubricants and emollients retard colonic absorption of fecal water and thus soften stool.

Mineral oil

Mineral oil is a nonabsorbable fat that softens stool and decreases water absorption, partly through its metabolism to hydroxy fatty acids in the colon. It is largely tasteless and has an oily consistency. It is most palatable if taken cold or mixed into a fluid (eg, orange juice). In many children given high doses, mineral oil causes seepage of orange oil into underwear, which can produce perianal pruritus.

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Laxatives, Stimulant

Class Summary

Stimulant laxatives act directly on the intestinal mucosa or nerve plexus. They alter water and electrolyte secretion.

Senna (Senokot, Ex-Lax, Geri-kot, Senexon, Senna Lax)

Sennosides are plant alkaloids that stimulate colonic salt and water secretion and promote colonic motility. They often produce abdominal cramping at high doses. Long-term use in animals has not been associated with any evidence of cathartic colon, tachyphylaxis, or secondary hyperaldosteronism.

Bisacodyl (Dulcolax, Bisco-Lax, Fleet Laxative)

Bisacodyl is a colorless and odorless compound that is poorly absorbed. It may be administered either orally or rectally. It increases colonic peristalsis and stimulates salt and water secretion.

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Laxative, Bowel Evacuant

Class Summary

Most enema preparations contain osmotically active agents that are not substantially absorbed in the colon. In all likelihood, the effectiveness of any particular preparation in the setting of encopresis depends more on the volume of the enema than on the composition of the enema solution.

Sodium acid phosphate (Fleet Enema)

Phosphate is divalent anion absorbed largely in proximal small intestine. Functions as osmotic agent and only small amounts are absorbed when administered as enema.

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