need help for 7 year old daughter

[jusshell]

As long as I can remember, my daughter has been constipated, although no dr would do anything for her till about a yr and 1/2 ago. At that time she went through 3 enemas, mag citrate to clear her system. Then she was put on miralax for about 6-8 mths to keep her regular. At that time she was weaned off it and the constipation started again. So, more mag citrate and 2 more enemas and she was supposed to be cleaned out again and put back on miralax. (The dr assures me it is safe if she needs to be on it the rest of her life.) So they put her back on the miralax around the beginning of Nov, although even on the miralax, she only had about 2 bowel movements from 11-28-06 to 12-28-06. So the dr gave her more mag ctrate and we went in today and she had another x-ray and she is very little better than she was. So, now I have to give her enemas again. The dr assures me that this will work this time. However, if it doesn't she said she will have the only other option of admitting her and put a tube down her nose and give her miralax through it and clear her out that way. So, she goes in tomorrow for a blood test to test for the gene for cystic fibrosis and then Mon for an x-ray to see if the enemas worked. The dr assures me this is normal and that she will just probably have to be on miralax the rest of her life. However, how can this be normal and how come she should have to go through this every couple months?? Does anyone know if there is anything that can be really wrong with her? This gets more and more frustrating and to think of her having to have another enema does not make me (or her happy as she s refusing to let me do it) happy. Sorry this is so long, I just need some help knowing what to ask the dr's about because they don't seem to care and don't have much to offer me. Thank you for your help. (She is finally starting to go by herself a little, but it's not much even with all the meds.)

[jusshell]

Ok, we just got out of the hospital. we are sure she is cleaned out. X-ray shows nothing there. So, basically what they have told us is that we monitor her from here and make sure she doesn't get backed up again. If she does being on the meds than they will look further into it. She has to sit on the potty 3 times a day and just try to go even if nothing comes out. She will stay on the miralax until further notice and she has a follow up with her dr Thurs. Bulike that. I will know to make sure to stay on top of things too. Make sure she doesn't have to go through this again. She has been through enough the past 2 days. Had the NG tube put don her throat. Which fell out about 3 hrs later even though she didn't jerk or anything. Then 3 different nurses tried to put it back and couldn't. So they gave her 16 ozs of miralax twice a day and 2 enemas. The dr did mention such things as hirschprungs disease. But from what I am understanding, they want to monitor this to see if this becomes a problem again before they think it's something like that. I do however plan to ask about the stool samples to see if they will do this. I will know more about the long term care of this Thurs when she sees her doc. Thank you all so much for your help. I am going to assume at tis point, as long as she is being monitored correctly, that it will be ok because they will catch it then if it is something more.

[chris088]

A related discussion, Chronic Constipation was started.

[buggnonu]

Hi shell....sorry to hear your child is having such a problem, I can relate I have had the same problem for as long as I can remember.I have done alot of research on the problem of constipation unfortunatly I had to have my large intestines removed. ANYWAY on to what I was thinking about your situation....I was reading about a nerve desease I think it was that effects young children....its called Herchsprungs where part of the nerves in the large intestines do not get the "signal" look it up and check it out and ask your doc about it. I wish you and yours the best of luck...my daughter also suffered from the very same problem and it hurts your heart to see them suffer...................bug

[ozark]

I think that your sister may have had a section of microcolon with the spagetti description. Hirschprungs usually presents at birth and xrays can diagnose it. But it doesn't have to be the whole colon and may present differently.  It may only be at the rectal sigmoid area.  When did your child start having bowel issues?  Did she have any problems as an infant? If this just started recently I don't think it's Hirschprungs. I just noticed she is 7 yrs old.  Has she seen a pediatric gi dr?  Do you live near a large hospital center or a childrens hospital?  I would probably insist on going to one.  This can be psychologically detrimental to a child to have to continue with enemas etc when it could possibly be due to a mechanical problem. It should be ruled out.  Good luck

[Idab]

Oh dear!  I went through a similar situation a year ago with my 6 year old daughter - but all I can say is unless there is certainty that the x-ray confirmed a blockage there is no need for enemas and this was verified by my paediatrician, in fact he was outraged when he heard that the ER had aministered not only 1 by 3 enemas over a 5 day period.  I and my daughter went through hell.  How you have endured it for so long, only heaven alone knows.  Once again, if x-rays and stool tests prove clear, you only need give your daughter liquid parrifin (this was prescribed by my paediatrician - Dr W de Wit - Wilgeheuwel Hospital - Johannesburg SA.  It took a few weeks/months as the trauma she went though with the enemas was the hardest to overcome, but I can say she is coping well now.  I am about to post another comment in response to no diagnosis found - you might want to read that one as well.

[Jackolynn]

I was reading about your issue with your daughter, what a ewwwwy situation having to deal with all that for that long. I feel for you and your daughter. I do have a friend who has a son that went through the same situation. You have to be carefull with your daughter because having that bad of constapation is painful, allot of stomach aches ect...Best solutions is to ask for a stool sample test for your daughter, chances are she may have an infection you are not aware of,including your doctor, that is causing her to have difficulty having a bowl movement. If say for instance your child was in childrens hospital and she was not pooping on schedule they would take her stool sample to make sure she did not have a virus or infection and that is how they test children but the doctor will never tell you to ask for a stool test as wierd as that is.So you ask your doctor for the stool test and he is not suppose to turn you down and if he does... you go to a walk in clinic and a doctor that will.Do not give up.My gf son was told he was lactose intolerent and he was not, always complaining and in pain, poor kid.. I imagine your daughter is like that too. Laxitive stuff did not work for him either and all they wanted to do was enimea and xray, the cheapest thing to do and the only thing they will do for her.They will chop it up to constipation so please ask your doctor for a stool test...I believe it is 2 bottles with presevitive in it and mix her stool in it over a 3 day period you take 2 samples different days... it will be something like ova and parasites and some more tests because she is a child still like bacteral infections and other stuff kay. Good luck and let me know how it goes.

[jusshell]

I read about Hirschprungs and I knew a little about it because someone else had said something about it to me. But I never really thought anything about it til you said it too. It does sound like it could be her. My sister had some sort of bowel obstruction when she was first born and had to have part of her bowel removed because it was like spaghetti, but my mom doesn't have much info about it and they had never given her a name for it back then. But she had surgery I guess around 24 hrs old. (she's 29 now) So maybe I can ask my daughters dr about it. Would you know if it could still be hirschprungs and her ever have normal bowel movements? I ask because when the dr first started her on the laxatives and enemas and got her cleaned out, she stayed on the miralax for maybe 6 mths or so and as long as she was having diarrhea, she could go. But as soon as the miralax stopped, the constipation was automatic! But they have no x-rays to prove that she ever really was totally cleaned outbecause they never did another one. So the dr thinks that maybe she never was cleaned out totally.

From what I read about crohns, it sounds like she would have diarrhea instead of being constipated.

She has had 2 small bowel movements finally today. Thank you all so much for all the info. The more informed I am I think the better I will be able to help my daughter.

[MLWTR]

Crohn's disease is another possibility. Chronic diarrhea is more common with Crohn's, but a minority of people end up with chronic constipation instead.

[ozark]

Has anyone mentioned Hirschprungs disease? To diagnose one needs to have biopsies of the colon.  Babies can show severe cases where the whole colon is not innervated, having severe constipation  and there can also be segmental areas of the colon that can cause constipation that is not as severe. I would look it up and see if this may fit your childs bowel habits.  I would also ask your pediatrician to check into this........maybe see a pediatric gi doctor.
good luck

[jusshell]

It is definitely better to give more fruits and veggies than the meds!! My daughter didn't even have her first bowel movement til she was almost 2 days old. Just before they let us go from the hospital. Even as a baby/toddler she was constipated. As potty training, she was the easiest of my 3 and was more afraid to have an accident in her panties and was alway running to the bathroom to make sure she went before she would have an accident. My oldest daughter would hold it. She would be too bisy playing or whatever and I always had to tell her the playing can wait, the potty can't. So I have an understanding of what holding is like and all and that's not this daughter. I have been over her diet with the dr and she doesn't think that's the problem. The only test that has been done was this am with the CF test and I agree, I think it will be neg. This was the only dr that even tried helping my daughter. Everyone else told me it was all normal and she would eventually grow out of it, but it just gets worse. Even when she's constipated she tries her hardest to go. I see her on the potty and trying and trying and nothing coming out. So I really don't think she's holding it at all. I wish it were that ad could be fixed easily:) Even when they supposively had her cleaned out and weaned off the med. she was cnstipated in a matter of days. So it is frustrating. And she still refuses the enema. So I don't know what else to do. I can't blame her for not wanting it. I wish the dr could say she has done every test and they have all come back neg, but she can't because she hasn't. Where we are, the dr's would have to send her off to a ped GI specialist and I don't think they want to, so I think they are just trying to assure themselves that there is nothing wrong so they don't have to deal with it.

[Felix'sMum]

...and I forgot to ask whether there is sufficient fibre in her diet? That may seem obvious, but if your daughter has an abnormally slow or "lazy" bowel, it may need an extra boost to get going and that has to take the form of increased fibre in her diet.

If there is a particular vegetable she likes and maybe one or two fruits, try her on 7 or 8 portions a day. You're probably giving her the recommended 5 helpings of fruit & vegetables as the norm anyway, but bumping up the fibre considerably might be enough to get things moving. Better to have to eat loads of fruit & veg every day than live on meds, right? Good Luck again!

[Felix'sMum]

How truly awful for you. My son is 6 and has some long-term health problems - he is so DONE with all the regimes and routines and hospital appointments and blood tests, just like your daughter. Trying to force her to have an enema must be a nightmare.

Apart from diagnosing chronic constipation, has anyone actually said WHY she's constipated? Is it an issue of poor bowel functionality? I doubt the CF test will show up positive so try not to worry about that too much; you would normally have picked up on other symptoms like long-term cough, poor weight gain, foul smelling BMs before constipation became a diagnostic clue.

I am more concerned for you to get to the bottom of the cause rather than just having to accept the long-term treatment of having to live on meds for the rest of her life....constipation is usually a symptom of something so you'd want to treat the root cause long-term, surely?

Are there any emotional/psychological issues surrounding your daughter's attitude to her BM's? You say the constipation has been there for as long as you can remember. but can you pinpoint when/how it began, even roughly? How was she as a baby? Did she have regular BM's then? When she was little did she go better in nappies than she did afterwards when she started potty training? Some kids have real deep seated issues about their BM's - it can be associated with seeing what they poo or even just becoming aware of the weird feeling of passing a BM and it sets up a vicious circle where avoidance of that makes them hold on subconsciously, leading to chronic constipation. It can even be caused after she had one original episode of constipation so the next time she passed a BM it hurt, and she got scared to go again in case it hurt, so got constipated again, so it hurt etc etc round & round.

If the doc genuinely says he can find no root physical cause for her constipation you might want to consider seeing a child behavioural specialist who could talk things through with her and find out whether there are issues in her subconscious which may be at the bottom of all this (no pun intended there!). My heart goes out to you; I hope you get things sorted real soon.

[Kevin Pho, MD]

The use of chronic laxatives is normally the approach for cases of chronic constipation.  Normally, this is integrated with behavior modification therapy to help with long-term control of constipation.

However, if there is a functional or anatomical abnormality, this needs to be corrected.  A lower endoscopy or a motility study can be considered to evaluate for this possibility.

These options can be discussed with the GI specialist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_