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Constipation with Encopresis — RACP Paediatrics MCQ

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ModerateGastroenterologyConstipation with EncopresisRACP Paediatrics

A 4-year-old has chronic constipation with overflow soiling (encopresis). He has hard stool palpable on abdominal examination. He holds stool during the day. What is the first-line treatment?

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Correct answer: D — Disimpaction with high-dose PEG (polyethylene glycol) followed by maintenance PEG

Functional constipation with faecal impaction requires initial disimpaction (oral PEG 1-1.5 g/kg/day for 3-6 days or rectal disimpaction if oral fails) followed by long-term maintenance PEG (0.4-0.8 g/kg/day) titrated to achieve soft stools. Behavioural strategies (regular toileting, reward systems) and dietary advice are also important.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Constipation