Treatment With Homemade Enema Leads to Colitis in Two Children

A national survey showed that only about 7% of consumers read warning labeling on over-the-counter products.

Hydrogen peroxide enemas often pop up in search results for homemade constipation treatments, however, a recent case report highlights the dangers associated with this remedy.

The case involved two siblings (2- and 9-years-old) who presented with bloody diarrhea and vomiting to the emergency department after receiving a hydrogen peroxide enema to treat constipation. The mother reported that after an Internet search, she had given both children the enema which contained hydrogen peroxide (concentration unknown) and warm water. The children were able to pass stool but an hour later the vomiting and bloody stool began.

An abdominal CT was conducted on both children which showed mucosal thickening of the rectum, sigmoid, and descending colon. The patients were admitted to the intensive care unit and were started on IV fluids; oral intake was withheld. The children improved quickly and were discharged 24 hours later with a prescription for polyethylene glycol laxative, 17g daily for constipation.

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The authors write that previous cases related to hydrogen peroxide enema have mostly involved older patients, and that to their knowledge, this is the first case of colitis associated with this type of enema in the pediatric population. Based on previous cases, the recovery period may range from 3 days to 8 months, depending on severity. While usually not fatal, use of this type of enema has led to bowel ulceration with necrosis and perforation. Conservative measures such as bowel rest and fluid resuscitation were used in most cases, but some required broad spectrum antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids. 

While over-the-counter hydrogen peroxide carries a warning labeling indicating ‘external use only’, the authors write that additional public education is needed to warn of the dangers of using this product in an enema. In addition to colitis, hydrogen peroxide enema use has also been linked to proctitis in patients looking to treat an enlarged prostate or prostate cancer. “Therefore, patients with unexplained colitis or proctitis may be queried about use of hydrogen peroxide enema.”

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