Abstract:

Objective: Childhood constipation is common and usually functional. Data for the drugs used in maintenance therapy of functional constipation is limited in childhood. Our aim was to evaluate the efficacy of senna, trimebutine and lactulose in children with functional constipation (FC) or functional fecal incontinence (FFI). Material and Methods: Patients  (2-18 years old) diagnosed as FC or FFI according to Rome III criteria who were treated with lactulose (n=36), senna (n=29) and trimebutine (n=33)were included. Patients completed a 0-5 Likert scale questionnaire about their symptoms. Stool consistency (SC) was evaluated by Bristol Stool Chart. Compliance and tolerance to treatment and side effects were recorded. Clinical improvement (CI) and pharmacoeconomic evaluation were performed. Results: CI in the senna group was significantly higher (p=0.036). Senna showed the highest improvement in SC (p<0.001) and decreased fecal incontinence (p=0.039). Abdominal distention, abdominal pain, nausea/vomiting and anal fissure were improved by trimebutine (p<0.05). Both senna and trimebutine decreased painful defecation and stool witholding. Lactulose improved anorexia and anal fissure. Senna was the most cost-effective drug. Conclusion: Treatment options for constipation should be tailored according to the predominant symptom. Senna may be recommended as the initial treatment for children with obesity and/or fecal incontinence, trimebutine in patients with abdominal distention,  abdominal pain,  nausea/vomiting or anal fissure, lactulose in patients with anorexia or anal fissure, respectively.  

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