According to recent NICE Guidance, all children and young adults with idiopathic constipation should be assessed for fecal impaction. The clinical guidelines described that a combination of history-taking and physical examination should be employed to diagnose fecal impaction. In patients with chronic constipation, overflow soiling and/or the presence of a palpable abdominal fecal mass and/or rectal mass should be investigated whenever indicated. In case fecal impaction is absent, maintenance therapy must be initiated. It was further recommended that oral medication regimen for disimpaction should comprise polyethylene glycol 3350 plus electrolytes, employing an escalating dose regimen, at the first-line. It was also stated that polyethylene glycol 3350 plus electrolytes may be mixed with a cold drink.

Additionally, the guidelines suggested that rectal medications should not be used for disimpaction, except in cases where all oral medications have failed; they should be administered only with patients’ and their guardians’ consent. Sodium citrate enemas should be administered only when oral medications for disimpaction have failed. The administration of phosphate enemas for disimpaction should be carried out under specialist supervision in a hospital/health centre/clinic, and only if all oral medications and sodium citrate enemas have failed. Manual evacuation of the bowel under anesthesia should be avoided, unless optimum treatment with oral and rectal medications has failed. It was suggested that all children and young adults undergoing disimpaction must be reviewed within a week of the procedure.