Extreme and severe cases of constipation can precipitate fecal impaction, with current therapies being both ineffective and unpleasant. A recent study evaluated the efficacy and safety of Movicol, a polyethylene glycol (PEG) + electrolyte solution (PEG+E), as a treatment for severe constipation and fecal impaction.

56 patients (between 17 to 88 years of age) with a history of chronic constipation and showing no bowel movement for three to four days (severe constipation), or no bowel movement for at least five days (fecal impaction), were included for the study. Abdominal and rectal examination or abdominal radiography was utilized to confirm fecal loading in all patients. Patients with gastrointestinal obstruction, evidence of delayed gastric emptying, or constipation secondary to severe inflammatory bowel disease were excluded.

All patients were rendered the same regimen, i.e. up to eight 13.8 g sachets of PEG+E (2 sachets at a time dissolved in 250 ml water; with a maximum of 1 L/day) over a 4–6 h period each day, with 1–1.5 h between each dosing, which was followed for up to three days.

Responders were described as patients with either improvement (passage of a moderate to a large volume of stool within four days of treatment initiation) or complete resolution (passage of moderate to large volumes of fecal matter along with the loss of palpable fecal masses in the abdomen and/or rectum). 

The results were as follows-

• According to the bowel movement data recorded by the patients, an excellent response rate was obtained: 50/56 patients showed successful response to treatment, among which 39 were complete responders and 11 patients showed improvement. 
• Investigator assessment of response was almost similar: 87.5%. 
• Improvement in all bowel movement measurements (stool volume, number of evacuations, stool form and ease of evacuations) was seen by Day 2. 
• The treatment duration was of two days(median). 
• The incidence of adverse events was found to be low, even for side-effects like abdominal pain and bloating, which are considered undesirable consequences of PEG+E administration. 
• No patient terminated the study because of an adverse event.

Thus, PEG+E when administered orally at a dose equivalent to eight 13.8 g sachets (1 L) per day over three days can prove to be a highly effective and well-tolerated therapy for treating severe constipation and fecal impaction.

Source- Current Medical Research and Opinion, 2005;21(10):1595-1602. DOI: 10.1185/030079905X65385