Safety and Efficacy of Milk and Molasses Enemas Compared With Sodium Phosphate Enemas for the Treatment of Constipation in a Pediatric Emergency Department

Objectives: The purpose of this study was to determine the safety and efficacy of routine milk and molasses enemas (MME) compared with sodium phosphate enemas for the treatment of constipation in the pediatric emergency department (ED). A secondary objective included the identification of factors associated with enema selection in the pediatric ED. Methods: This study was approved by the University of Texas Southwestern Medical Center Institutional Review Board. The study design was a retrospective comparative chart review. Medical records of patients who presented to the ED and received either MME or sodium phosphate enema for constipation between November 1, 2007, and November 1, 2008, were identified and reviewed for data collection. The following data were collected to determine safety and efficacy: baseline demographics, chief complaint, medical history, radiographic imaging, enema type, treatment dose, adverse effects, improvement in symptoms, time until defecation, failure of initial therapy requiring additional intervention, and time from treatment until disposition. Results: Both treatment groups had similar baseline characteristics. No statistically significant differences in treatment effect were noted between MME and sodium phosphate enemas. Several clinically significant trends were noted including the need for additional rectal treatment after administration of sodium phosphate enemas versus oral therapy after MME. In addition, there were 6 cases of treatment failure with sodium phosphate enemas versus 1 case with MME. Conclusions: No statistically significant differences were found between MME and sodium phosphate enemas. Based on our results, the 2 treatment options were found to be equally safe and effective.