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Soap Suds Enemas & ED Management of Impactions

July 5, 2016 7:03 am

A recent retrospective single-center study (CE Chumpiitazi et al. JPGN 2016; 63: 15-18) identified 512 patients (8 mo-23 years) who were treated with soap suds enemas (20 mL/kg of water with one packet of castile soap). Key findings: No serious adverse events were identified. “82% were successfully treated.”

While this large study provides a fair amount of reassurance, the associated editorial (pg 1-2) makes some key points:

ED diagnosis of fecal impaction is unreliable. “Abdominal radiographs are often performed…[but] have shown unsatisfactory sensitivity and specificity.” In this study, only 38% had reported history of constipation; thus a high number of children developed impactions without prior constipation. Thus, either many of these children were not impacted or the history was unreliable.
“SSEs are likely to be very effective, but so are phosphate enemas and milk and molasses enemas that have fallen out of favor because of safety concerns.”
In the editorial, until prospective studies are completed, the authors advocate considering oral PEG (high-dose) or ducosate enemas, normal saline enemas, glycerin enemas, mineral oil enemas, or bisacodyl enemas.

My take: While the editorial makes some valid points, particularly making sure that treatment for an impaction is needed, I think this study provides good preliminary data on the safety of soap suds enemas. As with all pediatric treatments, more high-quality studies would be welcome.

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