Rectal stimulation to relieve constipation in infants: is it safe?

Kalyanbrata Mandal, Abhishek Roy


Background: Physiological constipation is the most common cause of stool retention in neonates and infants. Functional constipation is the commonest type of constipation in children of Indian subcontinent with 3% worldwide prevalence. It is quite bothering to the parents when child has not passed stool for the last 3-4 days. Rectal stimulation by betel nut leaf stalk is a widely practiced home remedy in rural India over centuries to treat this physiological constipation in infants.

Methods: An OPD based prospective observational study was conducted in a tertiary care hospital of Eastern India. The cases chosen were 100 infants who underwent rectal stimulation for relieving constipation and another 100 infants who haven’t were the controls. Both cases and controls were followed up clinically as well by digital rectal examination and radiologically where indicated for next 6 months for any adverse outcome arising from rectal stimulation.

Results: Outcome on follow up was almost similar in cases and controls. Immediate evacuation of stool following rectal stimulation was seen in 90% cases. Majority of the subjects had an uneventful follow up. Functional constipation diagnosed by ROME III criteria was 30% in cases and 35% in controls. Habit formation and minor local ulcers in perianal region were also noted in few cases. Two cases and one control were diagnosed as Hirschsprung disease on follow up. All caregivers of cases experienced psychological relief following the practice.

Conclusions: Rectal stimulation is an absolutely harmless practice with insignificant outcomes.


Constipation, Digital rectal examination, Rectal stimulation

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