CONTACT: BECKY SOGLIN
Iowa City IA 52242
(319) 335-6660; fax (319) 384-4638
Release: Sept. 13, 2001
UI studies palatable laxative for children with chronic
IOWA CITY, Iowa -- Trying to treat constipation in a child
can be a difficult experience for child and parent alike. Milk of magnesia
and mineral oil -- two traditional remedies -- don't taste very good, which
can affect a child's ability to use them effectively as therapies.
However, families might now be more likely to turn to
using polyethylene glycol (PEG) 3350, a palatable powder-form laxative available
by prescription that can easily be dissolved in a child's favorite beverage.
University of Iowa Health Care researchers studied the optimal dosage at which
the therapy, without added electrolytes, can safely and effectively treat
constipation in children. The findings will appear in the September issue
of The Journal of Pediatrics.
PEG 3350 already had been studied as a treatment for adult
constipation; however, it was not clear what dose was safe and effective for
children, said Warren Bishop, M.D., UI associate professor of pediatrics and
director of the UI Pediatric Gastroenterology Clinic. Bishop co-authored the
study with Dinesh Pashankar, M.D., UI assistant professor (clinical) of pediatrics.
"Polyethylene glycol can replace traditional treatments,
including milk of magnesia and mineral oil, that have undesirable characteristics,"
Bishop said. "These older medications are effective but very difficult for
most children to take reliably."
Bishop explained that polyethylene glycol products that
contain salt and other electrolytes have been available for years. These solutions
are used to flush out the intestines of a person prior to surgery or colonoscopy
but also are very unpalatable because of their high salt content. The salt
is necessary to prevent salt-depletion when taken in large volume. However,
more recently, PEG 3350 in an electrolyte-free form has been made available.
"Our innovation is to use the PEG without salt in small
volumes each day in order to soften the children's stools and treat their
constipation," Bishop said. "Because we're using a small volume, we're not
causing a significant loss of liquid stool or electrolytes."
Bishop and Pashankar studied 20 children ranging in age
from 18 months to 11 years (average age 6 years) who had chronic constipation,
which means a stool frequency of fewer than three per week. Some of the children
also had encopresis, which is the leakage of soft stool around impacted stool.
"The typical child with chronic constipation has infrequent,
painful stools," Bishop said. "Many children in our study were fearful of
using the toilet. Some also were holding on to their
stools voluntarily and then having what we call overflow
incontinence -- leakage of the stool into their underwear."
PEG increases the water content of feces, making them
move more easily and painlessly through the intestines. After treatment with
PEG, the children's stool frequency increased from 2.3 to 16.9 per week, or
about two bowel movements per day. While that may seem higher than normal,
Bishop said the increased number of stools helps the children resolve their
"In addition to increasing the stool frequency, we also
aimed to allow the children to have stools that were soft to slightly runny
so that any pain associated with defecating would be alleviated," Bishop explained.
Children in the study had a marked improvement in stool
consistency, changing from hard to soft and slightly loose stools. Incidents
of soiled underwear in the nine children who had leakage problems also decreased
from 10 incidents a week to only slightly more than one.
Patients' reports of these improvements in their bowel
movements were noted rapidly, with 12 children reporting improvement within
the first week, and the remaining eight participants reporting success with
the therapy during the second week of treatment.
From the patient's point of view, a particularly important
aspect of the treatment is that the medication is tasteless, dissolves completely
and does not alter the taste of the beverage in which it is mixed. Children
participating in the study used beverages including Kool-Aid, fruit juices,
Crystal Light, water and cow's milk.
"The polyethylene glycol helped us achieve control of
constipation quite easily in all of the children studied, and it was uniformly
found to be palatable, so the regimen was therefore excellent," Bishop said.
This study was funded by Braintree Laboratories, Inc.,
the manufacturers of Miralax (PEG 3350).
As with all medical care, it is best to consult with a
personal physician before making any changes in your or a dependent's health
Parents interested in learning more about PEG therapy
for a child are urged to contact their family physician or the UI Pediatrics
Gastroenterology Clinic at (319) 356-2950. Visit the UI Pediatric Division
of Gastroenterology online at http://gut1.peds.uiowa.edu/default.htm
University of Iowa Health Care describes the partnership
between the UI College of Medicine and the UI Hospitals and Clinics and the
patient care, medical education and research programs and services they provide.
Visit UI Health Care online at www.uihealthcare.com.