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Sennosides vs magnesium hydroxide vs polyethylene glycol as a treatment for constipation in anorectal malformation: a randomized crossover trial.

  • 2025-08-26
  • Pediatric surgery international 41(1)
    • Butsarin Nate-Anong
    • Jiraporn Khorana
    • Sireekarn Chantakhow
    • Jesda Singhavejsakul
    • Kanokkan Tepmalai

Study Design

Type
Randomized Controlled Trial (RCT)
Population
15 patients with surgically corrected ARM and diagnosed constipation
Methods
A randomized crossover trial, each patient received all three laxatives in a random order for 21-day periods, separated by washout periods
Blinding
Open-label
Duration
21-day periods
Funding
Unclear

Purpose

To compare the efficacy and user preference of Sennosides, magnesium hydroxide (Mg(OH)2), and polyethylene glycol (PEG) in treating constipation in ARM patients.

Methods

A randomized crossover trial was conducted from January 2018 to December 2019. Fifteen patients with surgically corrected ARM and diagnosed constipation were enrolled. Each patient received all three laxatives in a random order for 21-day periods, separated by washout periods. The primary outcome was post-treatment fecal loading assessed by Leech score on abdominal radiography. Secondary outcomes included the rate of clean fecal loading (Leech score ≤ 6) and user preference scores.

Results

The mean post-treatment Leech scores were 6.67 ± 2.09 for Sennosides, 6.80 ± 2.37 for Mg(OH)2, and 5.80 ± 2.04 for PEG(p = 0.841). Clean fecal loading was achieved in 40% of cases with Sennosides, 46.67% with Mg(OH)2, and 60% with PEG(p = 0.655). User preference scores favored Sennosides (7.00 ± 2.36) over Mg(OH)2 (6.33 ± 2.94) and PEG (5.06 ± 2.28) with p = 0.582. No significant differences in treatment, period, or sequence effects were found, with the exception of a decrease in preference for Mg(OH)2 compared with Sennosides in the third treatment period (p = 0.045).

Conclusion

While PEG showed a trend towards better fecal clearance and Sennosides was preferred by users, no statistically significant differences in efficacy or user preference were found among the three laxatives.

Research Insights

  • Senna→Achieved Clean Fecal Loading

    Clean fecal loading was achieved in 40% of cases with Sennosides, 46.67% with Mg(OH)2, and 60% with PEG (p = 0.655).

    Effect
    Neutral
    Effect size
    Small
  • Senna→Improved User Preference

    User preference scores favored Sennosides (7.00 ± 2.36) over Mg(OH)2 (6.33 ± 2.94) and PEG (5.06 ± 2.28) with p = 0.582.

    Effect
    Neutral
    Effect size
    Small
  • Senna→Reduced Fecal Loading

    The mean post-treatment Leech scores were 6.67 ± 2.09 for Sennosides, 6.80 ± 2.37 for Mg(OH)2, and 5.80 ± 2.04 for PEG (p = 0.841).

    Effect
    Neutral
    Effect size
    Small
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