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Children's Health

Bowel problem

03/12/2007

Question:

My daughter is 10yrs old and she has had bowel issues from birth.As a newborn she had terrible trouble passing bowel motions the consistancy of the motion was normal.Now at age 10 she is on such high doses of laxatives to open her bowels that I`m concerned that these medications are doing her harm.Investigations into this discovered she had hydronephrosis of the kidneys and a neurogenic bladder.These have been dealt with except for the bowel.I have read that long term laxative use can destroy the lining in the bowel and she could end up with nutritional problems,bowel blockages and worse. Is this correct? And what other treatment could be used rather than laxatives? Doctors think she may have some sort of nerve/muscular disorder,but are unable to pinpiont exactly what it is. Any advice is greatly appreciated as she is getting worse and I am very worried what this means for her longterm health.

Answer:

It is very common for children with chronic constipation to have the issue from infancy into their adult years. It suggests an underlying physiological problem that will require patience and skill to manage well.

There are several chronic illnesses associated with chronic constipation. Hopefully your child's pediatrician has considered these. They include cystic fibrosis, diabetes, hypothyroidism (low thyroid), cerebral palsy (unlikely that this would have been missed for so many years), and lead poisoning. It also makes a lot of sense to suspect a gastrointestinal motility (movement) problem given the problems with her ureters and bladder.

Clearly your child should be managed by a pediatric gastroenterologist to ensure that the true cause of her constipation is discovered and that she has the best plan of care possible. If your child already has such a specialist and you are feeling dissatisfied with her care, ask for a referral to another pediatric gastroenterologist for a second opinion.

For the vast majority of children with constipation, laxative use is appropriate only for a relatively short period of time, 2-4 weeks, to clean out the bowel in conjunction with a prescription for fiber and increased water intake. However, there are medical indications for consistent use of laxatives, but this should not be an early choice until strong, persistent efforts have been made to increase fiber in the diet, improve fluid intake, increase the child's level of physical activity, and deal with any psychological issues that may contribute to the problem. This can take a year or more of nearly weekly medical visits either in person or by phone.

The good news is that research is NOT supporting a link between consistent laxative use and an increased risk of colon cancer or any damage to bowel cells. It is true that chronic use of laxatives does lead to an ever increasing need for higher and higher doses of the laxative. Bowel smooth muscle tone may also be harmed over time, contributing to ongoing problems with constipation.

I hope this information helps.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University