Pharmacological management of childhood constipation: Bridging today’s gaps with tomorrow’s therapies

Table 2 Types of enemas used in children with constipation

Type of enema	Mechanism of action	Adverse effects
Mineral oil	Reduce the water absorption	Staining of underwear with leakage
	And soften stools
	Lubricate hard fecal masses to facilitate expulsion
Soap suds enema	Hypertonic solution	Rectal mucosal irritation
	It leads to detergent-based mucosal irritation to stimulate defecation	Colitis
		Bleeding
		Rarely strictures
Milk and molasses	Sugary nature of the enema affects the intestinal lining and produces gas, leading to abdominal distension, increased intra-abdominal pressure and the generation of peristalsis	Hemodynamic instability due to the shift of fluid
	Fat in the milk lubricates the fecal mass	Cramping and abdominal pain
		Nausea and vomiting
		Rectal irritation
Olive oil	Lubricate the stool mass, facilitating excretion	Mild rectal irritation leading to discomfort
	Soften the stool bolus by retaining water and partially breaking down the fecal mass	Leakage causing discomfort
	Subtle enhancement of local peristalsis	Hypersensitivity reactions
		Abdominal cramps
Phosphate	Highly osmotic and draws water into the rectal lumen, softening stools	Rectal irritation leading to rectal pain and burning sensation
	Rapid rectal distension triggers peristalsis	Hyperphosphatemia
		Hypocalcemia
		Other electrolyte imbalances
Sodium lauryl sulfoacetate	Lowers surface tension between fecal mass and intestinal fluid, and allows water and lipids to penetrate hard fecal mass, softening it	Rectal irritation and burning sensation
		Abdominal cramps and discomfort
		Nausea
Sodium docusate	It reduces the surface tension of stool and allows water and fat to penetrate the fecal mass, making it softer	Rectal irritation
		Abdominal cramps and discomfort
		Nausea