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.