The stimulant laxative (sodium picosulphate, SPS) is also effective clearing the bowel in 81% [2] and is a liquid easily taken by children. PEG and a stimulant are commonly combined for cleansing the colon for colonoscopy [3]. Aim: find more determine how much stool is produced by combined PEG and SPS in patients with palpable fecaloma requiring disimpaction. Materials and Methods: The study was performed on 17 participants (8 males and 9 females, Mean age 9.1 ± 1.0 yrs, range 4–17 yrs) recruited from the a tertiary teaching

hospital. Inclusion criteria: 2 years chronic constipation, palpable fecaloma on presentation confirmed by presence of enlarged stool-filled rectum on x-ray. Participants were taught to fill in a daily TGF-beta inhibitor diary recording stool volume produced and laxative dose taken. Laxatives were given according to a predetermined dosage regimen taking high concentrations (4–8 sachets) of Movicol (PEG + electrolytes) on day 1 and 2. Each sachet of Movicol contained 14.7 g of PEG plus electrolytes and was made up

with 125 ml water per sachet plus an equal volume of juice or milk and 10–20 drops of SPS (Dulcolax SP) was added. Patients drank 125–250 ml per half hour using a fun approach (MOTIVATE). They continued to take 1 sachet of Movicol plus 10 drops of SPS for 14 days. Three subjects were excluded from analysis due to lack of data. Results: Over day 2–4, all subjects produced between 0.5 to 4.0 liters of stool (over the first 4 days). They continued to produce at least 250 ml of stool per day in the following 2 weeks (table 1). Mean total stool produced over 14 days was 4.2 ± 0.6 L. The subject’s

age and total stool volume produced by Day 4, 7 and 14 were fitted to linear regressions. medchemexpress There was little relationship between age and stool volume at Day 4 (r2 = 0.43, Gradient = 0.2), Day 7 (r2 = 0.40, Gradient = 0.27) and Day 14 (r2 = 0.30, Gradient = 0.36). Children were easily able to drink the large volume of PEG solution using the MOTIVATE method. Table 1 Number of patients and total stool volume produced Total Stool (L) 0.5–2.5 2.5–4.5 4.5–6.5 6.5–8.5 8.5–10.5 Day 1–4 12 (86%) 2 (14%) – – – Day 1–7 8 (57%) 5 (36%) 1 (7%) – – Day 1–14 5 (36%) 3 (21%) 4 (29%) 1 (7%) 1 (7%) Conclusion: For disimpaction in children with a palpable fecaloma and rectal enlargement, combined polyethylene glycol and sodium picosulphate given at high dose on day 1 and 2 are effective in producing large volumes of stool. The MOTIVATE method provided a fun way to drink the large volume of osmotic and stimulant laxatives and a successful and well tolerated method of disimpaction in children with chronic constipation and large solid stools in the rectum. 1. Candy, DC, et al, J Pediatr Gastroenterol Nutr, 2006. 43:65–70. 2. Atkin, WS, et al, BMJ, 2000. 320:1504–1508. 3.