Constipation
Because everybody has different bowel habits, constipation is not as easy to define as you would think. We will use the University of Virginia Health System's definition of constipation: bowel movements that occur less than every other or every third day, bowel movements that are large and hard, and, perhaps most importantly, bowel movements that hurt. Constipation is one of the problems that many children with autism may also suffer from. Many studies attest to this fact. Afzal, Murch, Thirrupathy, Berger, Fagbemi, and Heuschkel [Pediatrics. 2003 Oct;112(4):939-42], in a study of 103 children with autism, reported that moderate or severe constipation was more frequent in the autistic group than in the control subjects (36% vs 10%). They also noted that 54.4% of autistic children had moderate to severe loading (an accumulation of feces in the rectum and colon) or acquired megarectum (an enlarged rectum due to chronic overloading) compared with 24.1% of control subjects. Another interesting finding was that consumption of milk was the strongest predictor of constipation in the autistic group. That doesn't mean milk causes constipation but it may support the belief that the gastrointestinal systems of persons with autism handle milk products differently (see www.gfcfdiet.com ). Molloy and Manning-Courtney [Autism. 2003 Jun;7(2):165-71] studied 137 children with autism and found that 24 percent had a history of at least one chronic gastrointestinal symptom.
The University of Virginia Health System has prepared a very practical introduction to constipation that covers the problem as well as treatment strategies. To see this article, click on this link:
Chronic Constipation and Encopresis in Children
The article says there are three basic principles to treating constipation:
1. Empty the large intestine
2. Once the large intestine has been emptied, establish regular bowel movements.
3. Eliminate the pain associated with passing bowel movements.
See the article for their specific recommendations. Copy the article to share with your physician. It really is the most comprehensive and sensible article on constipation I have found. It also deals with some myths about constipation and laxatives.
Having suffered from constipation for a number of years, I may not be an expert but I have had some experience in establishing regular bowel movements (# 2, above, no pun intended). I can recall holding bowel movements in at a very early age. I do not know why I did it, I just did it. This progressed to chronic constipation and, eventually, a problem called an anal fissure. An anal fissure is a tear in the anal opening, rectum, or anal sphincter. It is extremely painful and tends to be a recurring problem. I suffered with this problem for about thirty years before finally having surgery. The surgery repaired the fissure and cut the anal sphincter to relieve the excessive pressure, which adds to the pain. While the surgery relieved the chronic pain, it did not solve the constipation problem. I will share how that was brought under control in the next section. For more information about anal fissures, follow this link: Anal Fissure Self Help Page
My Personal Method for Dealing with Constipation:
Disclaimer: I am not a physician and this information is not to be taken as medical advice. Consult your physician before taking any action.
1. Treat constipation as a serious medical problem. See your physician and, if possible, get a referral to a gastroenterologist.
2. Magnesium - Magnesium has long been used as a laxative. I take 266mg three times a day of an over the counter magnesium oxide with chelated zinc tablet (from Walmart). This keeps bowel movements moist and regular for me (sorry to be so graphic). A child's dose would certainly be less and every person will have to personally adjust the dose based on their own system. Be sure to consult your child's physician for dosage information. For more information on magnesium see: Magnesium.
3. Diet changes - Some foods are "constipating" for some people. Milk has been reported to be related to constipation in some persons with autism. Cheese is traditionally said to be constipating. Try to identify foods that affect you negatively. For me, going on the Zone Diet (by Barry Sears) helped me. The Zone Diet cuts out bad carbohydrates (processed foods, white bread, white rice, alcohol, sugar, etc.) and recommends a special balance of calories from carbs (40%), protein (30%), and fat (30%) at each meal. Doing this is said to keep your insulin level "in the zone" to help your body burn fat rather than store it. I don't know why the diet helps, but it seems to. For many people with autism the gluten free, casein free diet or the Specific Carbohydrate Diet helps with many of the symptoms of autism, to include constipation. For more information see www.gfcfdiet.com .
4. Prune juice - Prune juice is a tried and true method of staying regular. I drank a cup of prune juice each night to help have regular bowel movements. Currently, I do not take prune juice unless I anticipate a problem.
5. Vitamin E and a multivitamin - This is word of mouth. Vitamin E has been said to help - it cannot hurt. The multivitamin replaces vitamins that may not be absorbed due to the magnesium that may "wash out" other nutrients.
6. Exercise - I try to walk two miles three to four times a week. When I actually do this, I feel better physically and mentally.
7. Reduce stress - The pain added to the stress, of course. Once the pain was gone, much of the worry about having a bowel movement went away. But I still had to learn how to relax during a bowel movement and let nature take its course with no pushing or straining on my part.
The Lord helped me to learn how to leave all the other stresses of my life in His capable hands. Stress made my anal fissure worse and often triggered one of my bouts with pain. Learning to trust the Lord helped in all ways.
8. A recently discovered addition to my daily regimen is Acidophilus. This pro-biotic (good bacteria) seems to help keeps things regulated as well.
Here are some other constipation and related links:
Constipation - National Digestive Diseases Information Clearinghouse
The Specific Carbohydrate Diet - A.N.D.I.
Autism Bacteria? - Dr. Greene
Autism-Gut Connection - Dr. Andrew Wakefield
Autism and the Gastrointestinal Tract - Editorial by Drs. Quigley and Hurley