That's right, I said it... poop! I must admit, that even upon entering motherhood 8 years ago, I never before realized the joy I may someday find in the discussion of poop and it's presenting of itself during the many occasions that it has been greatly anticipated and long overdue.
However, having a little man living with a neurological condition changes up your priorities, settles your insecurities, and cures any level of modesty you may have previously possessed in regards to bodily functions, in this case we're talking constipation. Since one of the primary causes of constipation is lack of exercise, that greatly explains why all little ones living with debilitating conditions such as hydranencephaly suffer from constipation, not to mention that it is also a systematic symptom unfortunately associated with all neurological conditions. So, what are we to do to prevent this horrible discomfort for our little ones, even without any visible signs of discomfort, why should we do our part as parents to prevent constipation?
I'll be the first to admit, that I didn't notice any visible signs of discomfort with bowel movements that signaled any possible signs of constipation for Brayden. After further researching, and understanding how things work in there, the signs were obvious and I felt terrible that I didn't do more sooner. Even without the uncomfort level, it's still greatly unhealthy to not have things "flowing freely" as they should. Here's why, in a nutshell:
Chronically, constipation can cause a condition called megacolon, which is just as it sounds... an enlarged colon from being overly stuffed of poop. As all this stays in the colon, it only gets harder, drier, and larger, making the BM that much more difficult to overcome and pass. If it is difficult to pass, you can bet that our little ones are not going to want to pass them, and thus begins the vicious cycle of constipation. If they're holding it to avoid the pain associated with going, the problem only becomes much more of a problem.
To prevent constipation from getting to this level of chronic, the obvious way is through diet. Although this is the most obvious preventative, I know that it my case it isn't always the easiest. Although I am fairly fortunate that Brayden does fairly well with oral feeding, his diet is just like any other child's and varies considerably from day-to-day while also teetering on the verge of maybe containing every ounce of recommended fiber per day. I was also shocked to read that protein, such as eggs which I use as an additive to give more protein to Brayden's diet which does not include much meat, can cause constipation... we've since layed off the eggs!
On top of the battle over diet, is the fluid intake, and not enough fluids makes the colon "thirsty" and causes it to absorb the moisture in the poop as it passes through... making it that much more difficult for it to pass. My stubborn little man doesn't always like to drink water, or juice, or anything for that matter... so instead he eats fluid-full fruits and veggies, so I can sneak them in there.
Another preventative for constipation is plenty of physical activity, but in our case how is that possible? It isn't an issue of laziness, it is an issue of inability. All the stretching, repetitive movements, and therapies I can put him through will not create enough activity to be really classified as physical... so this preventative is much more difficult than it sounds like it should be.
In many of our little ones, the medications they are required to take to maintain a level of comfort and a greater quality of life also cause this uncomfortable condition also...primarily, anticonvulsants, which a large population of children with hydranencephaly and other neurological conditions take daily to control seizure activity. Pain control medications, mainly narcotic variants, blood pressure medications, and also iron supplements, which is well-known to cause constipation; all cause constipation as well.
Laxatives, to many that have found diet and exercise ineffective, are the next thought when it comes to preventative care for constipation. Here are the varying forms used to treat constipation
~Bulk-forming laxatives generally are considered the safest, but they can interfere with absorption of some medicines. These laxatives, also known as fiber supplements, are taken with water. They absorb water in the intestine and make the stool softer. Brand names include Metamucil, Fiberall, Citrucel, Konsyl, and Serutan. These agents must be taken with water or they can cause obstruction. Many people also report no relief after taking bulking agents and suffer from a worsening in bloating and abdominal pain.
~Stimulants cause rhythmic muscle contractions in the intestines. Brand names include Correctol, Dulcolax, Purge, and Senokot. Studies suggest that phenolphthalein, an ingredient in some stimulant laxatives, might increase a person’s risk for cancer. The Food and Drug Administration has proposed a ban on all over-the-counter products containing phenolphthalein. Most laxative makers have replaced, or plan to replace, phenolphthalein with a safer ingredient.
~Osmotics cause fluids to flow in a special way through the colon, resulting in bowel distention. This class of drugs is useful for people with idiopathic constipation. Brand names include Cephulac, Sorbitol, and Miralax. People with diabetes should be monitored for electrolyte imbalances.
~Stool softeners moisten the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Brand names include Colace and Surfak. These products are suggested for people who should avoid straining in order to pass a bowel movement. The prolonged use of this class of drugs may result in an electrolyte imbalance.
~Lubricants grease the stool, enabling it to move through the intestine more easily. Mineral oil is the most common example. Brand names include Fleet and Zymenol. Lubricants typically stimulate a bowel movement within 8 hours.
~Saline laxatives act like a sponge to draw water into the colon for easier passage of stool. Brand names include Milk of Magnesia and Haley’s M-O. Saline laxatives are used to treat acute constipation if there is no indication of bowel obstruction. Electrolyte imbalances have been reported with extended use, especially in small children and people with renal deficiency.
~Chloride channel activators increase intestinal fluid and motility to help stool pass, thereby reducing the symptoms of constipation. One such agent is Amitiza, which has been shown to be safely used for up to 6 to 12 months. Thereafter a doctor should assess the need for continued use.
The more natural approach which I prefer, and I have used after the recipe was shared with me by a fellow hydranencephaly family member, is Poop Goop. Poop Goop, despite it's funny-sounding name, is a seriously effective solution to constipation... the fact that it is essentially a fruit paste, makes it a bit more appealing and ranks it much higher on the taste-test charts too! Here's the recipe:
Ingredients8 ounces of dried prunes
6 ounces of raisins
8 ounces of dried figs
2 ounces of senna tea leaves
1/2 cup of prune juice
1/4 cup of brown sugar
1/4 cup of lemon juice
2 1/2 cups of water
1. Put the dried prunes, raisins, dried figs, senna tea leaves, and lemon juice into a pot and add the water.
2. Bring the contents of the pot to a boil slowly.
3. Boil the fruit mixture for fifteen to twenty minutes.
4. Remove the pot from the heat. Add the brown sugar and stir to dissolve.
5. Allow the fruit mixture to cool.
6. Use a mixer or put the mixture into a food processor. Gradually add the prune juice, while beating the mixture until it becomes a smooth paste.
7. Put the paste into a plastic, metal or glass container with a tightfitting lid.
8. Store the container of Poop Goop in the freezer.
9. Consume one to two teaspoonfuls each morning.
I actually recommend starting with 1/2 of a teaspoonful to test it's effectiveness & prevent any added discomfort. Generally, this does the trick. The greatest thing about this is it can be given every day if constipation is a never-ending battle.
The most important thing to remember, before simply treating the issue at home, is to address the issue with your child's doctor. They should first perform a variety of necessary tests to determine the exact cause of the constipation, and ensure that there is nothing physically wrong that needs to be medically addressed, aside from diet and lack of physical activity. A colonoscopy, or various other tests will likely ensue...
Once you've discussed any possible anatomical causes, poop goop is a great solution. However, do not ignore constipation as a phase that will pass... it can cause much more serious problems, like hemorrhoids, rectal prolapse (where part of the intestinal lining comes through), and fecal impaction (which is a poop blockage within the intestines) which is treatable if discovered but beyond uncomfortable!
And there it is... my knowledge of all things poop and how amazing it is to see when it comes. I can only comfortable discuss this, because I know beyond a shadow of a doubt that I am not the only parent that throws a mini-party each time their little one fills their diaper with more than moisture :) Happy pooping... hope that the poop goop is an easy solution for preventing any added discomfort for your little one and greater anxiety for you parents worrying over when or if it will come without causing an explosion...