Evaluation of Pena Protocol for Bowel Management in Children with Chronic Constipation

Background: Chronic constipation is one of the most common chronic disorders of childhood, affecting 1% to 30% of children worldwide.
Aim: To evaluate the efficacy and feasibility of Pena protocol of bowel management in children with chronic constipation
Patients and methods: This prospective cross-sectional study was conducted on 63 children with chronic constipation in the Pediatric Unit of General Surgery Department at Benha University Hospital
Results: Regarding the final outcome of Pena protocol for management of chronic constipation, the majority of cases had good response (93.7%) while 4 cases still had no response and needed surgery. According to the first step of Pena management among studied cases, which is enema, only 3 cases had antegrade enema and the majority had retrograde enema (95.2%) with mean dose of enema of 735, ranged from 200 to 1000 ml. For content of enema, one third used saline solution, also one third used glycerin, then 23.8% used phosphate, while 3 cases only used Castile soap, and another 3 cases used polyethylene glycol. Regarding the management by laxatives, 34.9% needed laxatives either due to increased number of enemas or increased dose with the majority used bulk forming laxative (59.1%), while osmotic and stool softener laxatives were used in 18.25 and 22.7%, respectively, among cases who used laxatives.
Conclusion: Pena protocol is effective and well-tolerated for bowel management in children with chronic constipation. Therefore, rectal enemas and oral laxatives should be equally considered as the first line therapy.