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.
Related blog posts:
- Improving ER Performance for Suspected Constipation | gutsandgrowth
- What’s Wrong with Ordering an AXR for Constipation … – gutsandgrowth
- Miralax Safety | gutsandgrowth
- Updated Pediatric Expert Constipation Guidelines | gutsandgrowth
- AGA Constipation Guidelines | gutsandgrowth
- Diagnostic tests hardly ever help patients poop | gutsandgrowth