? for momnstuff

iVillage Member
Registered: 02-03-2006
? for momnstuff
1
Tue, 04-13-2010 - 12:32am
I was reading old messages and noticed that you wrote that two of your children have neurological problems that caused constipation issues. I ask because i have a (nearly) 4 yo that I started potty training a year and a half ago. She has now been on miralax for a year because she started holding it in. We have had cycle after cycle of varying doses of miralax for so long now. I have been working with Docs who have done blood tests and x-rays and cannot seem to figure out what is wrong. Anyways, so what are the neurological problems that your children have and how did you figure out that was the problem?




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iVillage Member
Registered: 06-25-2005
In reply to: calimommi
Tue, 04-13-2010 - 1:17pm

My kids have an autism spectrum disorder, specifically Asperger's syndrome, which is a neurological problem. It is not uncommon for children on the autism spectrum to have constipation issues, but my 15yo dd issues are much more severe than typical even for children with autism.

Dd has had constipation issue pretty much since birth, particularly after she stopped breastfeeding. Initially the doctors weren't much help, believing that it was a behavioral problem (stool withholding) rather than a physical problem.

When dd was about 4yo, we finally got her on laxatives. When dd was 9yo she was finally seen by a pediatric gastroenterologist (GI doc). We suspected dd had autism before she was diagnosed at 12yo. When I proposed to the GI doc that dd constipation might be related to autism, she initially dismissed my ideas, but later the doc started to realize it made more sense.

Dd had many exams and tests, none of which revealed anything, until dd had an anorectal manometry (a balloon is inflated in the rectum to test muscle tone) a couple of years ago, which revealed that dd brain does not receive the signals that her bowels are full, so the brain never sends out signals for the bowels to start contracting to eliminate stool.

In addition to my two children on the autism spectrum, I also have two neuro-typical (NT) children who tend towards constipation. IBS runs in my side of the family (the autism runs in dh side of the family). I don't know whether my NT children have IBS or what's causing their problems. They have a fiber-rich diet, and they are very active children, so that's not the issue. They do tend toward allergies, so it's possible that allergies affect their bowels, but we haven't tested. I can usually control three of my children's bowels through a fiber-rich diet, but I do have to pull out the laxatives for all of my kids occasionally (15yo dd takes multiple laxatives daily).

You mentioned that your dd is a stool withholder, but you also mentioned that the docs have done testing and are perplexed. If you are pretty sure that stool withholding is the problem, then the docs should be focusing on overcoming the stool withholding. Testing won't reveal anything if the problem is withholding.

If the docs suspect a cause other than stool withholding, have they checked for allergies (esp gluten allergies) and ruled out a tethered spinal cord? Those are easy enough to test for and can cause big problems with the bowels. Are you seeing a specialist, like a pediatric GI? Do you feel like you and your doc are on the same page?

If you think that stool withholding is really the biggest problem, then you may want to go back to diapers for pooping, if that would make your dd feel more comfortable. The longer withholding occurs, the harder it is to break the habit. It can become such a habit that your dd doesn't even realize she's withholding.

If your dd doesn't want to use a diaper, make sure you keep her stool very soft so she can't withhold it. It should be pudding-like in consistency. If she can still withhold at that consistency, then you want to make the stool borderline diarrhea, to make withholding impossible.

You mentioned that you've use Miralax in varying doses. Was that to try to find a dose that works best? Miralax worked well for my dd, but I know that it doesn't work as well for some people. If Miralax isn't working as well as you'd like, you can try another stool-softening, non-stimulant type laxative such as Benefiber, Milk of Magnesia, or an Inulin-based product such as Fiber Choice or the new Metamucil Free-and-Clear.

You want to use as much laxative as is necessary to do the job for your child. For some people, that's a half dose of laxatives, for another child that might be multiple doses of laxatives. You just don't want to give your child chronic diarrhea which would dehydrate her, but otherwise don't be afraid to use enough laxative to do the job.

Stool-softening, non-stimulant laxatives are safe for long-term, daily use. The body does not become dependent on them. They just help hold water in the stool to prevent it from getting as dry/hard and difficult to pass. Stimulant laxatives, on the other hand, should NOT be used daily because the body can become dependent on them. Stimulant laxatives force bowel contractions to semi-quickly eliminate stool. Stimulant laxatives are often senna-based products (such as Senekot or Ex-lax), though there are other types as well.

If you think the stool withholding is a mis-diagnosis, then you might want to keep pressing for tests and answers. In some cases, it doesn't matter WHY the constipation 'cus the solution is the same: laxatives. Although we now know why dd has constipation issues, there's no real solution, so dd will probably just use laxatives her whole life. However, if the cause of the problem is something like gluten or a tethered spinal cord, then there are solutions that won't require a lifetime of laxatives.

Sorry my answer was so long, but I hope it helped a little. Best wishes!