Your child’s primary physician can investigate why constipation or diarrhea are happening and suggest initial treatments. A dietician can suggest changes in diet that may relieve some symptoms. A physical therapist can recommend exercises to encourage healthy movement of the bowels (motility). A gastroenterologist will consider more complex testing and/or treatments when needed. Complex care and palliative care clinicians can help with testing and treatments for constipation and diarrhea, and suggest strategies for promoting quality of life when these symptoms are present.
Motility, Constipation and Diarrhea
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Motility is the term for how the nervous system and the muscles work together to mix and move content in the GI tract. Constipation and diarrhea are symptoms of dysmotility, indicating that the GI tract is not working properly. Both are common in children with SNI, and both can cause GI discomfort. Changes in your child’s health status or baseline often include a shift in the consistency and frequency of bowel movements. For example, if a child becomes less active or loses their ability to walk or stand, constipation can become a greater issue. And sometimes bowel function changes without any clear trigger.
Motility can decline during an acute illness, or temporarily due to a neurological event like a seizure. Symptoms of dysmotility include abdominal bloating, discomfort, vomiting and constipation. Other issues, such as dehydration and side effects of certain medications, can chronically worsen motility. Chronic pain also may slow motility. Sudden changes in your child’s stool—the consistency, color, smell and/or texture—are something to discuss with your child’s primary physician. If difficulties persist, a gastroenterologist may recommend a specialized motility test, known as manometry or an antroduodenal motility study, that assesses whether the muscles in the esophagus are working properly.
Constipation
Constipation, often an indicator of dysmotility, is defined as having infrequent, often hard, stools. Constipation can cause abdominal discomfort, have a negative impact on appetite and even contribute to reflux and vomiting. For most children, the goal is to have a bowel movement daily, but regularity can vary from child to child. It can take time to determine the right balance of water intake, diet, exercise, time in a stander (in children who cannot support their weight), medications, supplements and/or use of suppositories or enemas to achieve a regular bowel schedule for your child.
Bladder function also affects intestinal function. Trouble emptying the bladder can worsen constipation. The reverse situation can also occur: constipation and episodes of functional ileus can worsen the ability to empty the bladder.
The medical team will work with you to assess the treatment strategy and make adjustments as needed. The team may look at liquid and fiber intake in the diet and medications that might be slowing down bowel function. The team may consider oral medications to draw water into the intestines in order to make stool softer and help increase bowel activity, or medications that stimulate the contractions of the intestines. In some cases, a child may need help prompting a bowel movement, which can be done using suppositories and enemas.
Diarrhea
Diarrhea is the frequent passing of unformed or liquid stool. It is less common than constipation in children with SNI. Viruses can cause diarrhea in children with SNI, just as it does in other individuals. Some genetic conditions predispose individuals to diarrhea, such as occurs in children with mucopolysaccharidosis (MPS) disorders. Antibiotics can cause temporary diarrhea and risk for diarrhea from the bacterium Clostridium difficile, also called C diff. Other causes include use of some supplements, liquid medications in a sorbitol base, or a feeding tube formula that has a higher concentration of nutrients than the body is used to. Laxatives can also cause diarrhea, especially if they are continued after constipation has improved. Children can become dehydrated because of the water they lose in their stool if diarrhea is severe or prolonged. Increased frequency of stool and toileting can also cause skin breakdown around the anal area, which can be a cause of distress and further complicate toileting routines.
We all feel uncomfortable when our intestines are not operating properly. You may be sensing that your child is experiencing bowel discomfort or pain but feel unsure about what to do. Determining the best management strategy or plan takes time, and there may be multiple possible paths forward. Changes in bowels can also be problematic when you are trying to enjoy time with your child outside the home. It is not always possible to find a changing station or place to clean up a child’s “accident.” You may need a treatment plan that considers and manages the timing of bowel movements. It is important to discuss any concerns with your medical team, so that they can understand your needs and help manage any stress on your family.