CONSTIPATION IN CHILDREN WITH NEUROLOGICAL DISEASES
Chronic gastrointestinal problems are of major importance for 80 to 90% of children suffering from neuromotor disabilities and those with neurodevelopmental disorders. Among these problems constipation occupies an important place and affects the quality of life of the child and the family. Other common gastrointestinal problems in these children are swallowing disorders and gastroesophageal reflux disease, which often accompany neuromotor and neurodevelopmental problems. These all contribute to a deterioration of the nutritional status of a child. In general, patients with neurological problems have bowel dysfunction due to loss of sensory and / or motor control.
Cerebral Palsy is the most common motor disability of childhood and is accompanied by constipation in 26-74% of cases. It is partially due to a disorder of the neuromuscular function of the intestine, but multiple other factors contribute. These include, abnormal movements and involuntary muscle contractions, use of antiepileptics, low levels of physical activity, and diet. Cerebral palsy as well as other neurological disorders (eg after Traumatic Stroke, Vascular Stroke, etc.) are characterized by rectal and sigmoid dilatation as well as increased anal sphincter tone resulting in faecal retention and constipation. Since the neuronal connections between the spinal cord and the colon is maintained bowel motility and the propagation of stool through the bowel remains intact.
Neurological bowel disorders are also found in patients with problems of the spinal cord such as, spinal dysraphism, syringomyelia, tethered cord, traumatic spinal cord injury and others. When the lesions involve the lower motor neuron to the intestine has no reflexes, it loses the ability for peristalsis resulting in slower bowel movement, reduced rectal dilatation and loose anal tone.
The result of the above is that there is both constipation and fecal incontinence. This thus is a complex disorder which is often accompanied by serious medical complications and problems in daily function and quality of life.
Spina bifida is the most common neural tube deformity and includes a spectrum of problems with varying severity. Lesions that are closed (such as spina bifida occulta, meningocele or lipomeningocele) often have fewer problems than those that are open. Open lesions often have several serious manifestations involving lower limb mobility bladder function.
In this population, intestinal dysfunction (constipation, stool incontinence or both) is observed in about 40 to 70% of patients.
These patients who suffer from varying degrees of constipation, diarrhea or fecal incontinence, should join the Bowel Management Program to gain better bowel control. The combination of oral medication, alterations in diet, enemas, and other treatment options result in the improvement of bowel disorders for patients with neurological causes of their constipation.