Polyethylene Glycol Versus Lactulose in the Treatment of Fecal Impaction in Children With Functional Constipation: A Quasi-Randomized Study

Abstract Background and Objectives Functional constipation is a common pediatric gastrointestinal disorder lacking an organic cause. Early diagnosis and cost-effective management are vital, especially in low- and middle-income countries (LMICs) like Nepal. This study compared polyethylene glycol (PEG) and lactulose in treating pediatric functional constipation. Methods A quasi-randomized study was conducted among 42 children (1–14years) at a tertiary care hospital from 10th May to 9th November 2023. Participants were alternately allocated into two groups: Group A received lactulose (4–6mL/kg in two divided doses) and Group B received PEG (1.5g/kg in two divided doses) for 5 days for disimpaction, followed by lactulose maintenance therapy (1.5mL/kg/day) for 30 days. Stool charts, clinical assessment, and parental reporting were used to monitor treatment response and adverse effects. Disimpaction success was defined as the passage of at least one watery stool in 24 hours. Key Findings PEG appeared to show faster disimpaction at day 3, but differences at days 3 and 5 were not statistically significant. Disimpaction response rates were 52.38% and 28.57% for PEG and 28.57% and 42.85% for lactulose, showing no significant difference [(χ2-2.471, df-1, p=0.116), (χ2-0.525, df-1, p=0.469)] at days 3 and 5, respectively. Patients taking PEG developed abdominal distension, while patients receiving lactulose developed decreased appetite. Meanwhile, abdominal pain and nausea were common. Conclusions While PEG showed a numerically faster early disimpaction response, the difference between PEG and lactulose was not statistically significant. Both agents were effective and well-tolerated, with lactulose remaining a cost-effective alternative in LMICs.