What are they?

In the treatment of constipation, the aim is for one soft but formed poo per day. Until the body can manage that alone, it will need help (from laxatives).

Laxatives are medications that help the body to get rid of poo. They are a standard and essential part of the treatment of constipation and have been shown to speed up improvement better than dietary changes alone. Most are available over-the-counter at a pharmacy but advice about dosage from a nurse or doctor is helpful.

How do they work?

There are two main ways in which laxatives for childhood constipation work:

some soften the hard poo and make it easier to pass (poo softeners)
some help the bowel push the poo out (stimulants or emptiers)

Which laxatives are available?

Some laxatives that are available for the treatment of constipation are listed below. There are regular changes to the brands which are fully or partially subsidised on prescription. Please check the information below with your doctor or pharmacist.

If a laxative is fully subsidised on prescription, it means there will be no charge for the medicine (although you may have to pay a prescription charge). If a laxative is partially subsidised, there will be a part-charge to pay. You may also have to pay a prescription charge. This will depend on several factors, including the age of your child and whether you have a Community Services Card. See Pharmaceutical charges explainedfor an explanation of what, if anything, you need to pay for your child's medicine, and why.

1) Poo softeners

lactulose (Duphalac)
This laxative comes as a liquid and is the most common and well-tolerated medication used for constipation in children. It may taste better if you chill it or mix it with some juice or milk from home. Duphalac is the only brand fully subsidised on prescription
liquid paraffin / mineral oil
This works by lubricating and softening the poo; too much, however, can make the poo very oily. It tastes best if you mix it with some chocolate milk or orange juice from home and then chill it before giving it to your child. This is not subsidised on prescription but is available over-the-counter at pharmacies. It can be quite expensive so it may be worth checking out a few prices
docusate / poloxalkol (Coloxyl or Laxofast)
This laxative comes as a tablet or drops (which are most suitable for children under three years of age) and is useful in babies and in children with mild constipation. This laxative is fully subsidised on prescription

A poo softener which is fully subsidised in some circumstances (your doctor will need to apply for a special authority to have it funded on prescription):

macrogol 3350 (Movicol-Half or Movicol)
This laxative comes as a powder which is mixed with water and can be flavoured with cordial if needed. It is particularly good for children with very hard or impacted poo. This laxative is only subsidised on prescription in certain circumstances, such as when your child has had ongoing constipation despite using other laxatives

Other poo softeners which tend to be used infrequently only after other laxatives haven't been effective:

docusate and senna (Laxsol)
This comes as a tablet. As well as being a poo softener, it works as a mild stimulant. It is fully subsidised on prescription
magnesium hydroxide mixture (Milk of Magnesia)
As well as being a poo softener, this works as a mild stimulant. This is not subsidised on prescription. Pharmacists need to manufacture the mixture so it may not be quickly available

2) Stimulant laxatives

These are useful for treatment of constipation in some situations but are not recommended for long-term use unless under medical supervision.

senna (Senokot)
This comes as a tablet. Your child may have diarrhoea or stomach cramps if the dose is high. Giving senna at night may reduce cramping and encourage a poo in the morning. Senokot is partially subsidised on prescription - there will be a part-charge for this laxative
bisacodyl (Lax-Tabs or Dulcolax)
This laxative comes as a tablet and suppository. It is fully subsidised on prescription

3) Other treatments

sodium picosulphate (Picoprep)
This should only be used under medical advice. It comes in a powder which is mixed with water which can be flavoured. It is useful for children with hard or impacted poo, if used over a few days to clear out the bowel. It needs to be followed by drinking plenty of water. It is not subsidised on prescription and is not recommended for ongoing daily use

Where to go for more information

On this website

Constipation

Soiling (encopresis)

International website

University of Virginia Health System (U.S.)

The University of Virginia website provides the following tutorial for patients and families:

Chronic constipation and encopresis

Acknowledgements

This fact sheet was originally developed in consultation with:

The Royal Children’s Hospital (Melbourne) Kids Health Info. Adapted October 2006 by Child Development Centre, Waikato Hospital.

Paediatric Department, Christchurch Hospital
Paediatric Department, Nelson Hospital

References

NASPGHAN Constipation Guideline Committee. September 2006. Clinical practice guideline: Evaluation and treatment of constipation in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
http://www.naspghan.org/user-assets/Documents/pdf/PositionPapers/constipation.guideline.2006.pdf [Accessed 4/03/2011]
Royal Children's Hospital, Melbourne. November 2010. Clinical Practice Guideline: Chronic constipation.
http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=11659 [Accessed 4/03/2011]
National Institute for Health and Clinical Excellence, U.K. May 2010. Constipation in children and young people.
http://guidance.nice.org.uk/CG99 [Accessed 4/03/2011]

Your notes

Endorsement

This fact sheet was endorsed by PSNZ - 04/03/2011

Copyright

Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2012

The Paediatric Society of New Zealand
http://www.paediatrics.org.nz

Starship Foundation
http://www.starship.org.nz

The Paediatric Society of New Zealand
http://www.paediatrics.org.nz

Starship Foundation
http://www.starship.org.nz

This fact sheet was printed on: 17-May-2012 10:36pm