Laxative Questions: Pediatric Bowel Management 2013
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- Osmotic laxatives like PEG can cause abdominal cramping, but cramping rates are equivalent across oral, enema, and NG disimpaction methods.
- Severe fecal impactions may require manual or rectal disimpaction before oral laxatives to avoid worsening abdominal distension.
- No evidence suggests PEG (MiraLax) negatively alters colonic microbiome; gut flora rapidly replenishes after osmotic laxative use.
- Fecal transplant is the only proven method to durably alter the colonic microbiome; laxatives do not produce lasting microbial changes.
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Cynthia Reyes, who says, do children have abdominal cramping when PEG is given for stool impacting? Does MiraLax negatively, and then her second question is, does MiraLax negatively alter the colonic microbiome? Yes, regarding the first question. Any osmotic laxative can give cramping at times. In all the studies that have been done, the amount of cramping during disimppaction versus enema disimpaction versus NGgo likely disimpaction, the amount of cramping is exactly the same. Of course, I suspect the question comes because if you have patients that have a very severe impaction. And those were, I'm sure not included in the studies that I described. Sometimes we need to do a manual disimpaction or a rectal disimpaction before you give laxatives orally, as we don't want to produce more distension. Now, there's no studies about the colonic microbiome in patients with, you know, on MiraLax or even with constipation. But as you know from even from antibiotic studies, after you take away the flora, the microbiome replenishes itself very fast. The only way to change the microbiome is by really doing a fecal transplant. So I suspect that there's no negative effects by using the PEG solutions, OK. Um, Andrea, you want to take it over from here? Thank you very much.