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Forum Name: Pediatric Topics
Question: 10 yr old son w/chronic constipation
|A060201 - Tue Jan 01, 2008 5:15 pm||
My 10 year old son has been diagnosed with chronic constipation 3 mths ago & Xray showed he's 100% impacted on both sides of his bowels and entrance out. Doctor said that taking Miralax once a day for 6 months to a year should cure him but that he should feel significant improvement in a few weeks. He said to give him adult fleet enema anytime he does not move his bowels in 2 days. My son saw some temporary relief in the first week but then after nothing. He also vomits because of the pain & misses alot of school. Now he is mentally affected by it. We saw the doctor again but he said to give it time. I've upd the dosage per the doctor but doesn't seem to help. He does get diarrhea every so often but I have not seen a real bowel movement in weeks. I can't understand if adults are cured by Miralax then why doesn't it help my 10 year old son? Can anyone suggest anything else? I am scheduled to take my son to a specialist for a second opinion but am at my whits end because my son is in agony.
|Dr. Chan Lowe - Wed Jan 02, 2008 11:10 pm||
Chronic constipation is a difficult issue to resolve. As your doctor has suggested it takes six months to a year to completely resolve the issue. The problem is that when the intestines are impacted for a long time they loose their ability to recognize the sensation of being full. When this happens the stimulus to go to the bathroom goes away, making the constipation even worse.
The cycle is broken by keeping the intestines normal sized for six months to a year to let them regain the ability to recognize when they are full. This is done by keeping the stool very soft, almost diarrheal, for the several months. Miralax is a good stool softener and works well. A standard dose is 17 grams per day.
In patients where there is already impaction from hard stool filling the colon, miralax takes much longer to work if it works at all. The reason is that the hard stool is much more resistant to stool softener effect.
In your son's case, if the fleets enema was unsuccessful I would recommend that you talk to your son's pediatrician about using a medicine called Golytely. Golytely is a medication similar to miralax but much more powerful. For it to work it takes a large volume, often a rate of 300 ml's per hour into the intestines is needed for a total of 4, 8 or sometimes even more liters of the solution. If the person is able to drink this amount rapidly enough it will work; however, often children are unable to drink this much so they may be admitted to the hospital and the medicine may be given by a nasogastric tube until the stool is clear so that the intestines are cleaned out. Then the miralax can keep the stool from becoming impacted.
Seeing a GI specialist will be helpful in managing this problem. The key is keeping the stool soft and establishing regular bowel habits. Without these things successful resolution will be very difficult.
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