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Are daily enemas necessary to treat constipation/encopresis?

Daily enemas (for as long as a month or more as some recommend) are not necessary to successfully treat encopresis.  If, during the initial cleanout, a child still has dry, hard stool in her rectum after having been given a lubricant (e.g. Mineral Oil) and/or a water retention laxative (e.g. Miralax) to soften her stool, as many as one (1) to three (3) successive daily enemas may be necessary to completely remove her impacted stool. However, following the removal of the impacted stool, a water retention laxative at a dose sufficient to make her stool the consistency of pudding or applesauce will usually prevent an impaction from reoccurring and therewith the need for any additional enemas.

Some healthcare providers prefer to use rectally administered laxatives rather than orally administered laxatives for cleanouts. Enemas and suppositories remove excess stool from the rectum more quickly and predictably than oral laxatives, however, most children resist them, often strenuously, and parents are uneasy about giving them. Therefore, since daily enemas are not required for the successful treatment of encopresis and since giving daily enemas almost always causes conflict between children and their parents, the vast majority of healthcare providers including pediatric gastroenterologists recommend oral laxatives rather than rectal laxatives for the ongoing treatment of encopresis.