A Novel Agent for Faecal Disimpaction in Paediatric Functional Constipation: Sodium Picosulfate–Magnesium Citrate

AIM: Faecal disimpaction is the first step in the management of functional constipation in children. Rectal enemas and high-dose polyethylene glycol are conventional options for faecal disimpaction but may be poorly tolerated. This study aimed to evaluate oral sodium picosulfate-magnesium citrate (SPMC) as an alternative for faecal disimpaction in children with functional constipation. METHODS: This was a single-centre retrospective study. Patients aged 1-17 years with functional constipation who received SPMC for faecal disimpaction between July 2024 and July 2025 were included in the study. Clinical and radiological data were retrospectively reviewed. Treatment success was defined as the absence of rectal faecal impaction on post-treatment radiography. SPMC was administered twice on the same day, with the second dose given 6-8 h after the first. Each sachet was dissolved in approximately 150 mL of water. RESULTS: A total of 203 patients received SPMC. Faecal disimpaction was successful in 175 patients (86.2%). No statistically significant differences in treatment success were observed between Bristol Stool Form Scale types 1 and 2 (p = 0.358) or between stool frequency groups (≥ 3 vs. < 3 defecations per week; p = 0.248). Faecal impaction persisted in 28 patients (13.8%). Of these, eight (28.6%) received another course of SPMC, 13 (46.4%) received high-dose PEG, four (14.3%) received a three-day enema regimen and three (10.7%) did not pass any stool. Of the latter three patients, two received a rectal enema and one underwent a contrast enema. No serious adverse events were observed. CONCLUSIONS: Oral SPMC appeared to be an effective, safe, and well-tolerated alternative to enemas and high-dose PEG for faecal disimpaction in children with functional constipation. Its oral administration and single-day regimen may offer practical advantages over conventional disimpaction methods. Further studies are warranted to validate these findings and determine its role in clinical practice guidelines for paediatric constipation management.