Constipation or functional acquired megacolon is a disorder that has as its hallmark an enlarged and poorly functional colon.

As stated last week, the causes lead to stool being held in the colon which in turn dilates the colon which further compounds the problem by making it difficult to effectively move your bowel.

The lower colon and rectum become filled with stool chronically which leads to a second problem, the loss of stool awareness. Normally, when stool hits the rectum, you feel a desire to defecate.

When the signal is always present in response to the rectum being chronically full, you lose the sense of stool awareness — akin to when you enter a room with a buzzing light sound and after 30 minutes, you no longer notice it.

Losing the stool removal signal coupled with the colonic dilation makes the treatment of constipation a long term problem.
It is believed to take 3-6 months or longer to get the colon back down to normal size.

Putting it all together:

To fix a problem like constipation requires a long term approach including diet, stress reduction, movement, medicines, herbs and micronutrients.

1) We need to get the defecation signal back. Therefore, we need to start inducing the gastrocolic reflex by sitting on the toilet for 5-10 minutes after meals. This will help a child re-hear the signal to go to the bathroom.
2) We need to clean out the lower colon and rectum to allow the intestine to shrink back down to normal size. This can be accomplished by a few different routes: enemas, or natural or pharmaceutical laxatives like triphala/magnesium citrate/senna keep the colon empty of stool for a prolonged period. Ask your provider for treatment protocols and dosing.
3) Begin stress reduction techniques. Mindful meditation and relaxing breath work are adjunctive therapies to reduce baseline sympathetic overtone.
4) A high fiber diet is of paramount importance. I highly recommend reducing or preferably removing all dairy from the diet until the issues are long resolved. The best sources of fiber are from vegetables, legumes and fruit. Beans, berries, artichokes and oats are awesome foods for constipation.
5) Move daily and often. Consider yoga. Exercise will help increase bowel activity.
6) Consider acupuncture for troublesome cases.
7) Avoid all drugs that slow bowel activity. Opioids, anti-hypertensives, diuretics, iron supplements, aluminum containing antacids and most psychiatric medicines are some of the notorious ones.
8) Consider biofeedback for children with behavioral issues related to their constipation.
9) Drink lots of water daily.
10) Consider taking a high quality probiotic or synbiotic.Move and eat fiber,
Dr. M

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at newsletter@salisburypediatrics.com