Constipation

The SMA parent overview

Constipation issues is something that, as the parents of a child with SMA, you will probably face at some point. Constipation can be difficult to diagnose because it's easy to lose track of the last BM you child had.  When the child becomes uncomfortable from constipation it is often mis-interprided as other problem.

Constipation

For instance, you may notice the following with constipation

Increased heart rate
whining or irritability
slight fever

 

These symptoms are also the same thing to look for when the child is coming down with a cold.

miralax

The best thing you can do it be proactive about BMs and keep track of them so you won't unknowingly get behind. If you child currently has issues with this from time-to-time, start administering Mirolax with their evening meal. Mirolax is a fine powder and mixes well. It is gentle and, unlike some harsh stimulant laxatives, it will not cause cramping or overly runny stools.  If you do choose to use a stimulant laxative, we hear Sennakot works well.  We recommend you ask your pedatrician before deciding to take a stimulant laxative or stool softener.

Glycerin

If you do become behind on your BM schedule, the best method is to deliver a glycerin enema. A glycerin enema is a small bulb filled with liquid/jelly glycerin that you insert into the rectum then pinch the bulb to deliver the glycerin and keep it pinched as your remove the enema.  This generally produces a BM within a few minutes due to the stimulation of the rectal muscles. The reason to use pediatric glycerin enemas instead of "standard" water enemas is simple.   If you child is still using a diaper, a water enema is going to be ejected along with what else is up there.  1-2oz water in = 1-2oz "water" out plus your 2-3 days of fecal matter is going to require something larger then a diaper to catch all that fluid. The bulb (pictured) is much smaller and a jelly so it's easier to contain.

Another tip that really helps your child with their BMs is positioning.

Often putting them into the proper position can cause a BM to occur.  We choose to have our daughter on her back and push her legs back lightly against her stomach as if she was sitting. 

There are hundreds of little tricks parents have developed to help in this area. 

The point this article is trying to impart is:  constipation can often show the same signs as a low-grade sickness.  Rather then being confused and possibly mis-diagnose an illness, make sure to factor in the last time your child had a good BM.  If it's been more then a day or two, try for a BM and see if your child's mood/symptoms improve. 

Constipation

The Nurse's lesson on constipation.

Unresolved constipation can lead to what is known as a “fecal impaction”. If it reaches this point other potential complications come into play. An impaction is classified as a large mass of hardened stool that has completely occluded the passageway of the rectum. Individuals that are prone to constipation, i.e. those afflicted by degenerative muscular disease such as SMA, as also more prone to fecal impactions due to the decreased motility of the colon.

Symptoms:

Watery stool

If you notice that your child has not produced a bowel movement in anywhere from 2-3 days and you notice your child suddenly has liquid stool or diarrhea, this does not mean that you have resolved the issue. Water will often build up pressure and leak around the obstruction. This is not the time to give your child medication for diarrhea! Consult a physician if this occurs.

Irritability

This is just a form of communication for your child. Pain, abdominal cramping, bloating, elevated heart rate and fever (even low grade) can all cause irritability. And his/her inability to communicate these symptoms will lead to frustration and increased irritability. Please check ALL of these possibilities and treat them accordingly.

Increased irritability during feeds

Your child’s body knows that there is something wrong. It also knows where the problem is. So if you true to put more food into a constipated child or one with an impaction, his/her body will fight you every step of the way. If you provide bolus feedings you may want to decrease the amount as well as the intervals at which you feed. If too much gastric upset occurs, your child may be forced to vomit which, as you know, can lead to many complications of its own.

Treatments

Prevention

This is always the best treatment there is. Not just for constipation and impactions but for all potential problems. This can be accomplished with sufficient fiber in his/her daily diet. Frequent positioning can also help stimulate the bowels.

Enemas and Osmotic Laxatives

However, use these sparingly as your child’s electrolyte balance is fragile and is likely to be compromised by the over use of these. Magnesium Citrate is a popular osmotic laxative but may cause severe cramping.

Glycerin Suppositories

This is usually successful in at the least dislodging the stool but may not soften it enough for it to be expelled through the anal canal in which case breaking down the stool digitally can assist in passing it completely.

Severe cases sometimes require surgical removal of the impaction and removal of part of the bowel tissue that has become necrotic.

Please take great care in monitoring for these potentially severe complications. Also, natural alternatives are especially good to consider because it is very easy for your child to develop a dependence on bowel medications, for both constipation and diarrhea. Do not hesitate to contact your gastroenterologist for any questions or concerns you may have about these matters.

If you have any special techniques that work well for your child, please share them in the comments section

Special Thank for helping with this article

Kristin Banjany, Brianna McDanel