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

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.