CONSTIPATION – WHEN THE GOING GETS TOUGH

Featured in the Summer 2017 edition of the Autism Eye Magazine written by Stella Chadwick.

CONSTIPATION AND CHILDREN ON AUTISM SPECTRUM

Gastrointestinal (GI) issues are some of the most common health concerns parents raise with regards their children on the autism spectrum. Studies have repeatedly shown that the prevalence of GI symptoms in those with an autism diagnosis is consistently and significantly higher than the average population. The key end result of these symptoms is higher levels of inflammation throughout the body, including neuroinflammation (inflammation in the brain).

Constipation is on top of the list of symptoms most commonly experienced by children with autism. We should really be calling it “constipations” since there are several types of constipation, each requiring a unique approach. A child should have a bowel movement 2 to 3 times a day and the ideal stool should be sausage-shaped, soft and easy to pass as well as being chestnut coloured.

If your child regularly goes a day or more without having a bowel movement then it may be important to address the underlying cause to avoid potential complications down the line. If bowels are not opened daily they can contribute to overall toxicity and damage the gut.

In clinical practice, there is overwhelming evidence that in many cases the root cause of these GI disturbances can be traced back to several key circumstances. Please see Table 1 for the most commonly observed factors.

IMPROVING BOWEL FUNCTION

One of the best things we can do to improve bowel function is to ensure that there are adequate levels of hydrochloric (HCL) acid in the stomach to help break food down properly, cleave nutrients off, sterlilize pathogens, and signal the release of Intrinsic Factor, necessary for B12 absorption. HCL levels in the stomach can weaken due to inadequate co-factors such as zinc, histidine and folate but mostly due to congested liver and gallbladder as a result of high toxic load and infections.

An indirect way to raise HCL levels is to support the liver. The liver needs lots of B12 both in the forms of methylcobalamin and adenosylcobalamin, as well as folate. Other supplements to consider are; dandelion and burdock, milk thistle, vitamin C, vitamin E, a host of minerals, especially selenium as well as glutathione, essential fatty acids, and amino acids. For the best foods to support liver function see Table 2.

You can directly promote HCL production by taking 1 teaspoon of fresh lemon juice mixed with 1 tablespoon of water, a few minutes before the main meal. Drinking celery juice (ideally on an empty stomach) is an extremely powerful way of healing the digestive tract and supporting HCL levels – many can feel the benefit in less than a week. A whole head of celery run through a juicer would be ideal. However, most children cannot drink that quantity and find pure celery juice too bitter so a combination of 4 sticks of celery with ½ a cucumber and a pear put through a juicer is refreshing and more tolerable.

Poor microbiome, where the balance of bacteria and yeast in the gut has turned in favour of those that are unhelpful has been long implicated in GI symptoms. Specific strains of bacteria have been found to be particularly helpful in helping resolve constipation. Bifidobacterium lactis BB-12 found in Optibac Bifido and Fibre is an excellent choice as is VSL3, and Symprove liquid probiotics.

The strain, Bifidobacterium longum has also been found to be helpful – an example of a product containing this strain is the Life Extensions Bifido GI Balance. If dairy can be tolerated then Bifidobacterium lactis DN-173 010 – found in Dannon and Activia and Lactobacillus casei shirota found in yakult may all be helpful.

TYPES OF CONSTIPATION

Hard Stools

Hard stools, like rabbit droppings are likely due to inadequate fluid intake, lack of soluble fibre (fruits and vegetables) and possibly food intolerances. The medical solution is generally to prescribe Movicol and sodium picosulphate.

Movicol is a preparation of polyethylene glycol (PEG) and works by causing water to be retained with the stool to soften and bulks up the stool. Although PEG derived laxatives are deemed to be safe, they may disrupt the gut eco system and may cause other complications such as haematuria (blood in urine), bleeding from the rectum and severe stomach cramps.

Using laxatives can be helpful in the short term but it is far more beneficial to address the underlying issues of constipation and correct fluid and fibre intake or address food intolerances, particularly dairy containing foods which can often be the culprit. Also consider digestive enzymes and improve hydrochloric acid production in the stomach.

Poor motility

Poor motility is when the bowel becomes stretched and peristalsis struggles to move the stool along in the colon – using Movicol in this instance can soften stool but it will make the bowel stretch even more as the content expands, causing tremendous discomfort and further inflammation.

A recent study has found the herpes group of viruses, including Epstein-Barr virus, chicken pox virus, and cytomegalovirus in the neurons of the colon of those with unexplained chronic constipation. This is an incredibly important, yet rarely considered link as it is very much reflected in clinical observations. To deal with poor motility it is important to rule out or treat any potential infections as a primary step.

There are also supplements which can help with motility, especially those containing a combination of 5-HTP, which stimulates enteric neurons, vitamin B6 as P5P, acetyl-l-carnitine, which supports autonomic neuronal health, and a fairly high dose of ginger which is both antispasmodic and anti-inflammatory.

Impaction

Impaction is a common type of constipation and can be tricky to treat and is usually when the bowel movement alternates between constipation and diarrhoea. This can be really painful and can manifest as a bloated belly, night waking, dramatic changes in mood and behaviour and is especially important to address quickly.

If you suspect that your child is suffering from impacted stools then it is extremely important to get a referral to a gastroenterologist 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 and consider foods in Table 3 below to help.

Supplements such as magnesium citrate or magnesium oxide, probiotics, aloe vera juice and digestive enzymes can all be helpful.

Straining

Straining due to inflammation is when a child has to repeatedly strain to get stool out – this is not likely to be an issue with motility or stool consistency but could be due to anal sphincter inflammation, and food sensitivities and is a vicious cycle situation.

The more the child strains the more inflammation is perpetuated – anorectal manometry, where the pressures of the anal sphincter muscles and the neural reflexes are measured can be carried out to find out if this is an issue. The focus should be on reducing inflammation and one of the most helpful strategies is to ensure that food intolerances are not contributing to the symptoms. It is also important to ensure that your child has lots of anti-inflammatory foods.

See Table 4 for top anti-inflammatory foods.

Ileocecal valve (ICV) problems

The ICV valve is half way between the belly button and the right hip bone. The ICV separates the small intestine from the large intestine. The ICV is normally closed and only opens to pass bolus from the small intestine to the large.

In the case of an abnormal ICV, there is an increased likelihood of small intestinal dysbiosis due either to the backflow or prolonged holding time of the small intestinal material. The ICV can be closed manually – there are therapists who specialize in this procedure.

Foods that may irritate the ICV are; beans and lentils, grains, seeds and nuts, raw fruit and vegetables, onions, garlic and leeks, hot spices, caffeine and fermented foods.

Muscle or Nerve problems

This is also known as dysmotility and occurs when the intestinal tract loses its ability to coordinate the muscular contractions of the bowel. This usually happens when there has been untreated persistent and chronic constipation.

There is 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.

Summary

In order to deal with constipation in an effective way, it is crucial to ascertain the type of constipation you are dealing with and rule out the relevant contributing factors. There should not be a one size fits all solution to this very common problem which can cause a lot of distress for children and their families.

 

TABLE 1

 

TABLE 2

 

TABLE 3

 

TABLE 4