Constipation
Constipation is a common gastrointestinal complication in children with neuromuscular disorders. The cause of the constipation may be immobility, inadequate fluid taking, abdominal muscle weakness, smooth muscle involvements in neuromusculary disease, low fiber diet, gastrointestinal dysmotility (may be related to underlying disease). A careful history taking, together with abdominal and rectal examination will be sufficient to diagnose. Abdominal examination may reveal fecaloid masses. It is important to evaluate the perianal site for fissures, skin tags, anal tonus and sensation. Rectal digital examination should be performed to identify the placement and size of rectum, and also the consistency and amount of stool. In the suspicious of the surgical abdomen, abdominal radiography and ultrasound may be performed. The colonic transit time assessment may be used in treatment resistance patients. A slow colonic transit time was reported in patients with demonstrated in the children with brain lesions, DMD and tube feeding children6,15,17,65.
Simons JP et al66. hypothesed that the Valsalva maneuver increases in subglottic pressure, but tracheostomy tube may lead loss of this pressure and may predispose constipation. But they found no relation with tracheostomy and constipation in their study66.
Treatment of constipation should be individualized to the patient. If there is stool in the rectum, previously a fecal impaction should be performed. Enamas and polyethylene glycol (per oral in dosage of 1.5 g/kg/day) are given for 3 consecutive days and continue till a clear and liquid defecation. The fecal impaction treatment may be prolonged to 6 days. In maintenance treatment, polyethylene glycol 0.8 g/kg/day or lactulose 1-2 ml/kg/day is required. The risk of aspiration pneumonia due to aspiration of mineral oil and polyethylene glycol should kept in mind. Tube feeding patients should be reviewed for water intake and formula content. Fiber content formulas may be preferred in tube feeding patients65.