Countless
children in the United States are diagnosed with chronic constipation every
year. Many pediatric GI specialists will tell you that it is the most
common condition that they see, accounting for nearly 25% of all visits.
There are many factors that can cause this, and most cases of
constipation require a variety of treatments to resolve. Each family must
take the time to discover both the physical and environmental factors that are
contributing to their child’s problem, as constipation tends to have both a
physical and emotional component.
Many of us have heard of the ‘gut brain’ but don’t really know
what it refers to. This is the enteric nervous system, which can not only send
and receive messages, but also respond to emotions. Your gut, or entire
digestive system, contains over 100 million neurons - this is more than are
found in the spinal cord! It is no wonder that gut health is so
influenced by emotions. For this reason, almost all children and adults
who are diagnosed with digestive diseases and disorders must address both
physical and emotional symptoms.
For children who are diagnosed with chronic constipation, there is
likely more than one factor involved. If a child has even one episode of
constipation that results in hard and painful stool, they may internalize a
feeling of fear or expectation of pain when the need to pass the next stool
arises. Some children will instead hold the stool in, rather than face
the pain of attempting to pass it. Like the colon, the rectum can also
absorb water, so stool that remains unpassed in the rectum gets harder.
This can make it even more difficult and scary for the child to pass.
It becomes a vicious cycle of withholding and subsequent painful stool!
This can cause both a rectal and bowel impaction if not addressed in a
timely manner. Sometimes small pieces will break off, so called ‘rabbit
pellet’ stool that some parents observe in their toddlers and young children.
Parents might think this is just their kids ‘normal’ stool, and not know
that it’s because there is a large mass stuck inside. Withholding for
long enough can cause such a large blockage that only soft or liquid stool can
fit around it. Children with this condition will pass frequent very small
loose stools. In younger (and occasionally older) children this may
present as encopresis, or soiling. This occurs when small amounts of soft
or liquid stool leak from the rectum without the child’s knowledge, staining
the underwear. Many parents won’t realize that the cause of this is
either chronic constipation or a rectal or bowel impaction. Other signs
of a rectal impaction include increased urination or wetting accidents.
An overly full rectum can put a large amount of pressure on a small
child’s bladder, causing accidents or bedwetting.
Diet of
course plays a crucial role in helping your child get relief from constipation.
Children should be drinking plenty of water every day. If
constipation is severe, try organic no-sugar-added juices such as apple, peach,
pear, plum, or prune. (Fun fact, many ‘p’ fruits are also high in
fructose and promote bowel movements!) Adding 2-4 oz of aloe juice to other
juices will soothe and lubricate the intestines. Many kids are resistant
to high fiber foods, but encourage them to eat carrot sticks or celery sticks
with almond butter and raisins - (bonus for more fiber!), or other crunchy raw
veggies that they like. Many kids become constipated from an excess of
pasteurized dairy products. Eliminating all dairy other than butter and
yogurt might help your child. If your kids will eat broccoli with
cheese try buying a raw milk cheese from your local health food store as raw
milk tends not to have the same constipating effect. Adding organic raw
coconut oil, organic ground flax seeds, or organic chia seeds can also
encourage softer bowel movements. Many kids love the texture and taste of
chia pudding which can easily be made or purchased already prepared at most
health food stores.
Over the
counter laxatives and enemas should be avoided until needed as an absolute last
resort. Some GI specialists will recommend a ‘clean out’ for your child
to relieve the impaction. They will likely recommend senna-based
laxatives, Miralax, magnesium citrate, or a combination of all of the above.
If your doctor recommends this, ask if it can be done with magnesium
citrate only. Senna-based laxatives not only cause painful cramping, but
can quickly becoming habit forming. Miralax is also habit forming, and
while less so than senna laxatives, has never been approved for use in
children, despite the fact that many doctors prescribe it regularly for long
term use. There are many natural products that can be used to keep the stool
soft and moving that are not habit forming. Organic oils are very
lubricating to the intestines and can be given daily - raw organic coconut oil
has a laxative effect for many people. Others to try are organic sesame
oil or olive oil.
In
addition, address any emotional issues that your child might be having.
Is there a negative attitude in the home surrounding defecation?
Does your child feel the need for a certain amount of control?
Harsh punishment for encopresis or soiling will only make the problem worse.
Many kids thrive on somewhat of a schedule during the day. No need to be
militant, but kids like to know what’s coming up next. A particular
effective strategy is that of ‘toilet sitting time.” Pick one or two
times during the day when you know you will be home, and have your child sit on
the toilet for 10 or 15 minutes. Give them a book to look at it if they’d
like. Have a stool for their feet to encourage a more squat-like
position, and give them some time to see if their body will relax enough to
have a bowel movement. Having ‘sitting time’ at the same time every day
will encourage your child’s body to move the bowels at that time. Many
adults naturally have a bowel movement in the morning. If mornings are
not rushed and there is time for your child to sit on the toilet for a while,
try that. If evening is a more calm time in your house, try sitting time
after dinner. Don’t expect immediate results. This is a complex
problem that will involve a fair amount of work on both you and your child’s
part. Seek help and support from other parents or a professional if you
are getting frustrated or not seeing progress.
Regular chiropractic care can be a critical aspect of managing
your child’s chronic constipation. The message that a child needs to
defecate is sent from the intestines and rectum to the brain. If the
spine is maladjusted in any way, a young child will not receive the message, so
to speak. If your child is not consciously realizing that they need to
defecate, stool will continue to harden in their rectum. In addition,
many children will have been constipated or withholding stool for a long time
before parents realize that something is actually amiss. By this time,
the child’s rectum can be stretched out, and they won’t even receive the
message that their rectum is full and needs to be emptied until the stool is
too large to pass comfortably. One simple adjustment may be all your
child needs to break the cycle! Other children require more frequent and
regular care to maintain a healthy frequency of bowel movements. A case
study presented here http://www.sciencedirect.com/science/article/pii/S1479235408000588 demonstrated that chiropractic care not only increased
the frequency of bowel movements in constipated children, but that the stools
were “described as soft without the accompanying straining, pain and rectal
bleeding.” A more in-depth study can be found here: http://drdianemeyer.com/Dr%20Meyer.pdf
Chiropractic
America describes in easy-to-understand terms how chiropractic care helps
relieve both the symptoms and some of the underlying causes of constipation: “Chiropractic adjustments (particularly in the lower spine) may
help relieve constipation in certain individuals. Muscles in the intestine push
stool to the anus, where stool leaves the body. Special nerve cells in the
intestine, called ganglion cells, make the muscles push. These nerves connect
directly to the celiac ganglion, which also innervates the stomach, liver,
gallbladder, spleen, kidney, small intestine, and the ascending and transverse
colon. The celiac ganglion, in turn connects to the spinal cord (and the brain)
through nerve roots that exit the spine in the lower thoracic and upper lumbar
region. Pressure on these nerve roots caused by misalignment of the
vertebrae in this area may interfere with the normal function of the bowel as well
as other organs of the digestive system.”
If your
child is suffering at all from constipation, even just occasionally, come see
us at Pea and the Pod. Like many health issues, constipation is easiest
to relieve when addressed early.
