This week's tips on constipation is based on an article I wrote for Autism Eye and you can find the full article on our blog here.
What is a healthy bowel movement?
When trying to improve your child’s digestion it’s good to know what you are aiming for. Healthy bowel movements should be at least once a day, ideally two to three times a day (basically one per meal). Stools should be a smooth sausage shape, dark brown in colour with no undigested foods, mucus or strong foul odour. If your child is going less than once a day, or if their stools are hard small pellets or cracked and lumpy – they are constipated.
Types of constipation and support The different types of constipation have different causes and require specific support. Here are the main types so you can assess your child and some simple steps you can do to help support bowel health. As always, it's important to take your child to the doctor if they suffer from chronic constipation so they can be assessed and serious issues ruled out. You can then decide the best way to support their bowel health once you know the root cause.
Hard stools
Hard stools, which can range from hard cracked lumpy stools to small pellets like rabbit droppings, are likely due to inadequate fluid intake, lack of soluble fibre (fruits and vegetables) and possible food intolerances.
Increasing fluid and fibre will help as will ruling out food intolerances. Dairy is one of the more common foods that can contribute to constipation so it may be worth removing dairy for a couple of weeks to see if this helps - making sure to replace it with other nutritious foods. Magnesium citrate or magnesium oxide can also help soften stools and are more gentle on the system than using laxatives like the often-prescribed Movicol. These are covered in the supplement of the week below.
Poor motility
Motility is how the bowel contracts and relaxes to move the stool along the colon (also called 'peristalsis'). If stool starts to back up and stretch the colon it can be hard for the bowel muscles to move.
To deal with poor motility, it is important to rule out or treat any potential infections first as recent studies have shown some common viruses (like chicken pox and cytomegalovirus) can impede the nerve cells in the smooth muscles and slow down bowel contractions. This will need to be done by a health practitioner who can help you assess if viral load may be an underlying cause.
Some supplements can also help with motility, including those with 5-HTP, vitamin B6, and acetyl-l-carnitine. It's important to work with a health professional before giving your child any of these supplements. A fairly high dose of ginger has also been shown to stimulate peristalsis and can be given as teas, cordials or chopped up and put into food or smoothies.
Impaction
Impaction is the most severe form of constipation and can alternate between constipation and diarrhoea so it’s important to make a note of symptoms and not assume a child is not constipated if they have many runny stools during the day. This condition can be really painful and can manifest as a bloated belly, night waking, and with dramatic changes in mood and behaviour.
If you suspect that your child is suffering from impacted stools, then it is extremely important to get a referral to a gastroenterologist from the GP for a thorough review. In the meantime ensure that there is adequate fluid intake and rule out food intolerances such as those to gluten, dairy, corn, soya and eggs. Supplements such as magnesium citrate or magnesium oxide, probiotics, aloe vera juice and digestive enzymes can also help ease symptoms while you wait for appropriate assessment.
Straining
Straining is when the child has to work hard to push the stool out and is likely due to anal sphincter inflammation. This causes inflammation and irritation and the child may start “withholding” or avoiding bowel movements to avoid the discomfort. This can lead to a vicious cycle and be very distressing for the child.
A doctor can check the anal sphincter for reflexes. At home, you can focus on reducing inflammation by giving lots of anti-inflammatory foods and ruling out food intolerances. A handy chart of our top anti-inflammatory foods can be found on the blog post I mentioned earlier.
Ileocecal valve problems The ICV separates the small intestine from the large intestine and is located half way between the belly button and the right hip bone. The ICV is normally closed and only opens to pass digested food from the small intestine to the large. A ‘stuck’ ICV can be both caused by and a contributor of constipation. Some osteopaths are trained in visceral osteopathy and can help massage the valve so that it closes and opens appropriately.
Some foods may irritate the ICV and include beans, lentils, grains, seeds, nuts, raw fruit, raw vegetables, onions, garlic, leeks, hot spices, caffeine and fermented foods.
Dysmotility
Similar to poor motility, dysmotility occurs when the intestinal tract loses its ability to coordinate the muscular contractions of the bowel due to poor messaging in the nerves. This usually happens when there has been untreated persistent and chronic constipation.
This needs to be assessed by a doctor who may recommend a procedure called colonic manometry, which measures how well the muscles and nerves in the colon work that can help ascertain the level and type of damage that is present.
And finally… Please read the rest of my article in the blog for other ways you can support your child’s digestive health. There are simply too many things to discuss in one newsletter and each child is different. There is no ‘one size fits all’ approach though the basics of good hydration, adequate fibre with fruits and veg is definitely the right place to start!
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