The study, “Comparison of three therapeutic interventions for chronic constipation in paediatric patients with cerebral palsy: a randomised clinical trial,” was published in the journal Gastroenterology Review.
Constipation is a common problem in children with neurological disorders, including those with cerebral palsy (CP). It can result from a combination of factors, including poor diet and reduced intestinal mobility.
“Usual treatments offered to children with constipation include education, consumption of foods that are high in fiber, increasing drinking of fluids, exercise, and using stool softeners and laxatives,” the researchers wrote.
Polyethylene glycol (PEG) and Motilium are two medications widely used to treat constipation. PEG is an osmotic laxative that works by increasing the amount of water in the stool, making it softer and easier to pass. Motilium is a dopamine antagonist that works by increasing the activity of smooth muscles surrounding the stomach and intestines, promoting gastrointestinal mobility.
In the study, a team of Iranian researchers led a small randomized, double-blind trial to evaluate the effectiveness of PEG, Motilium, and both agents combined, for the treatment of chronic constipation in children with CP.
The study included 50 children (29 boys and 21 girls), with an average age of 5, all of whom had CP and chronic constipation.
Participants were randomly divided into three treatment groups: 17 received PEG (0.5 g/kg/dose); 15 took Motilium (0.2 mg/kg/dose); and the remaining 18 were given both in combination. All treatments were administered three times a day, for two weeks. The children were evaluated after completing their assigned treatment.
A “satisfactory” response to treatment was defined as having more than two bowel movements per week, with no pain while defecating, no fecal incontinence, and no blood in the stool, and also having soft stools on abdominal and rectal examinations.
After two weeks of treatment, satisfactory responses were observed in 10 children (58.8%) given only PEG, and in one (6.6%) given only Motilium. In the group receiving the combo therapy, 17 (94.4%) children had a satisfactory response to treatment.
“The best response was observed in the group that received PEG and Motilium, followed by the group that only received PEG,” the researchers wrote.
Further statistical analyses also showed the use of PEG was associated with improvements in the number of bowel movements and stool consistency. However, PEG did not seem to have a significant effect on fecal incontinence or the presence of blood in the stool.
The fact that the combo therapy was more effective than either treatment alone, the researchers said, is likely due to the different mechanisms by which they work. This could allow the use of different means simultaneously to effectively treat constipation; each mechanism could specifically address different factors that contribute to the problem.
“The effect of addition of Motilium to PEG is probably due to the effect of Motilium on the upper [gastrointestinal] tract and improvement of gastric functions,” the researchers wrote. “On the other hand, PEG affects defecation due to its osmotic effect, which results in non-painful defecation.”