Constipation Archives

Dr. Stoll: Constipation in child with SID

I have a 3-1/2-year-old son who is the "poster child" for your article "Ask Dr. Stoll - Stool Withholding and Consipation in Children." My son's stool withholding issues are complicated by the fact that he has Sensory Integration Dysfunction as well as hypotonia and global apraxia (oral/motor/verbal). He was constipated frequently as an infant (which we have been told was due to the hypotonia), but the occasional glycerine suppository always resolved it. For the last year or more, we have come to realize that, rather than trying TO defecate, he is actually trying NOT to defecate. We're not sure which is the chicken and which is the egg -- did being constipated so frequently and having painful induced bowel movements make him decide it's just not worth it, or has he been withholding all this time (due to his sensory integration issues -- doesn't like the sensation), causing himself to become constipated?

I am encouraged by your suggestion of the mineral oil/Metamucil combination, but wonder about your opinion on this issue in relation to a child with SID. Chelation has been suggested to us, although we have not had our son evaluated by any naturopathic physician as yet. What is your opinion on this?

Thank you so much for your time.

Follow Ups:

• Re: Dr. Stoll: Constipation in child with SID (Archive in constipation.) Walt Stoll 07:39:35 11/23/02 (0)
• P.S. Lori 00:32:17 11/22/02 (2)
  • Re: Sensory Dysfunction, constipation: Had to butt in here Reader 12:05:22 11/22/02 (1)
    • Re: Sensory Dysfunction, constipation: Had to butt in here LoriW 12:45:32 11/22/02 (0)

In Reply to: Dr. Stoll: Constipation in child with SID posted by Lori on November 22, 2002 at 00:27:27:

I mentioned above that glycerine suppositories resolved my son's constipation as an infant. I neglected to mention that, for the past year or so, suppositories are no longer working. Enemas worked for a while, but those are even failing now. Three different (traditional) physicians have suggested/prescribed Miralax, but this has also failed (after two months of treatment) because he is able to withhold most if not all of anything thicker than liquid stool. We have begged, threatened, encouraged, bribed, and punished. When stool does manage to get past him, we praise him and make a big fuss, even reward him, but we cannot convince him that "pooping" is a good thing. I feel that this situation is getting rather desperate.

Follow Ups:

• Re: Sensory Dysfunction, constipation: Had to butt in here Reader 12:05:22 11/22/02 (1)
  • Re: Sensory Dysfunction, constipation: Had to butt in here LoriW 12:45:32 11/22/02 (0)

In Reply to: P.S. posted by Lori on November 22, 2002 at 00:32:17:

I don't think that he doesn't poop because he doesn't like the sensation - it's pretty much programmed into the human species. I think that a child with SID doesn't poop because he often doesn't FEEL the signals telling him that he has to go. And if he's very constipated, that compounds it even more because the large stool blockage stretches out the colon and makes the sensation even more mild. So not only doesn't he want to poop because it hurts to pass such a hard, large stool and it isn't worth the pain, but he often doesn't even know that he has to. Does he ever say that he doesn't feel like he needs to go, even when you know he does?
As for the rest, there are music listening programs which are supposed to help with bladder and colon signalling problems, along with auditory processing, etc. If I were you I'd take him to a good, progressive children's occupational therapist and ask about this program, which stimulates the central nervous system, along with a sensory diet which will kick-start his vestibular system and maybe make him more sensitive to this type of stimuli -- if he is an underreactive type.
A great book to read is "The Out of Sync Child." It's actually the only book I've ever found about Sensory Dysfunction, though I know there must be others.
And I highly recommend Dr. Stoll's program - using both fiber and mineral oil. Check under ARticles on Health, number 24.

Follow Ups:

• Re: Sensory Dysfunction, constipation: Had to butt in here LoriW 12:45:32 11/22/02 (0)

In Reply to: Re: Sensory Dysfunction, constipation: Had to butt in here posted by Reader on November 22, 2002 at 12:05:22:

Reader,

Thanks for your input. I have, as a matter of fact, read "The Out-of-Sync Child" and also recommend it very highly. I have also done a lot of research into SID and feel that I understand it very well. My son is on both ends of the SID spectrum -- hyposensitive in some things and hypersensitive in others, and not consistent in either one. Every day is a new adventure to see what he will tolerate and what he won't. He is currently occupational therapy three times a week and has been making a lot of good progress with his sensory issues, but this one still has us stymied.

My son is nonverbal, but it is VERY obvious from his actions and behavior that he does feel the urge to defecate, that he doesn't like it (for whatever reason we just don't know yet), and that he is doing everything within his physical strength to keep from doing it. In fact, he will actually come up to me and "tell" me (he uses some sign language) that he has pooped, and when I go to change his diaper, there's nothing there, or just a "skidmark". He's obviously only referring to the urge, which he has successfully pinched through.

I read Dr. Stoll's article outlining the mineral oil/Metamucil program and am certainly going to give it a try.

Thanks again.

Lori

In Reply to: Dr. Stoll: Constipation in child with SID posted by Lori on November 22, 2002 at 00:27:27:

Hi, Lori.

You have hit upon the reason why suppositories and enemas are never solutions to this problem: They eventually stop working.

I see no reason why the stool witholding protocol would not work here even though it may take a little longer because of his SID--listen to Reader. Your only problem is that as you approach, or even pass, the optimum dosage combination for him, you will have messes to clean up until he begins to associate the feeling of fullness with the need to "go" and also is gratified to notice that there is no pain with the movement.

Once he gets to that point, I would stop the praise and reinforcing activity associated with a BM. You have to deemphasize this activity. If he were a little older (a few years) I would even transfer the responsibility of cleaning up and throwing his soiled cloting in the wash and finding clean clothes to put on to him--not as a punishment but as a way for him to take total responsibility without anyone else knowing about what has happened. Not at this age, however. The best you can do now is to just stop any reinforcing behavior.

Let us know how he does and how YOU do.

The main thing is that the "missing link" for the connection between SID & this problem with the bowel has finally been written by the world's foremost expert in this area. Ask your library to get you a copy of "The Second Brain" by Michael Gershon, MD, published in 1999 by Harper/Collins.

Let us know what you learn.

Walt