Bowel trouble

axel2020

Hi everyone I’m new to the site and have a 24year old daughter with CP. For the past few months she’s been struggling to open her bowels even with medication and lockdown has made the situation worse as she’s isn’t able to access and hydrotherapy. She is under a gastric consultant but so far not much help. I was wondering if anyone had any tips or ideas to help her. Many thanks 

Cher_Alumni

Hello @axel2020 and welcome to our online community   It's great that you found us.

Just to let you know, I've moved your post to our Cerebral palsy category and am tagging in @Richard_Scope our Specialist Cerebral palsy information officer so he can offer support the next time he is on the community.

This NHS webpage offers practical guidance on how to combat constipation and includes a video on how to treat it.  Whilst my initial thoughts thoughts are, is is your daughter drinking enough water?  Ideally she should be aiming for 8 glasses of water a day (2 litres) - is she able to manage that? If this is a problem that has persisted for a while, I'd make sure to contact your consultant and advise him of the situation again and how much it is impacting your daughter's daily life.

One other thing to consider is asking for a referral to a dietician.  If that hasn't already been done, maybe it's an option worth exploring.

If your daughter could do with some company during lockdown, she is more than welcome to join our fortnightly zoom café.  This is a virtual meeting where our members with Cerebral palsy (aged 20+) get together to have a chat and discuss different topics.  Visit this thread for more details if you think it might be something she'd be interested in

All the best and I hope her constipation gets better soon.  

Richard_Scope

Constipation is a common problem for many children and young people with cerebral palsy. The cause is not always clear. It may be due to reduced mobility, certain medications, not enough fluid intake or related to difficulty eating enough fibre. If your child does have constipation the following tips may help.

Encourage foods that contain fibre

• Soluble fibres found in fruits, vegetables and oats are the best source of fibre in the management or prevention of constipation.
• Encourage some of the following high -fibre foods on a daily basis:
  • Wholegrain cereals (e.g. porridge, wheat biscuits)
  • Wholemeal pasta and rice (may be eaten whole or ground)
  • Fresh, stewed or canned fruits
  • All vegetables – raw, cooked, mashed or pureed (leave the   skin on)
  • Baked beans, lentils, dried peas and beans

These foods can be eaten whole, mashed or pureed depending on your child’s feeding ability.

• Avoid unprocessed bran as this is too harsh on a young child’s digestive system and can make constipation worse.
• Some children with eating and drinking difficulties may not be able to eat enough high fibre foods regularly and fibre supplements may be required. Talk to your doctor or dietitian about which fibre supplements may be suitable for your child.
• If your child is fed using a gastrostomy, a commercial formula with fibre may be useful. Talk to your dietitian about a formula that may be suitable for your child.

Fluid

• Encourage a good intake of fluid. The amount of fluid your child requires depends on how old they are (refer to fluid information sheet for more detail). Thicken drinks as required and remember thickened fluids are just as hydrating as thin fluids.
• Pear juice or prune juice may help with relieving constipation.
• Good sources of fluid include water, milk, juice, formula, ice, iceblocks, jelly, yoghurt, custard, ice cream.

Activity

• Limit periods of inactive sitting time as much as possible.
• Assist or encourage your child or change positions regularly to include lying in different positions, sitting and standing. Encourage your child to participate in ‘huff and puff’ activities for a minimum of 60 minutes per day.
• Your physiotherapist will be able to suggest individualised activities your child can participate in and recommend a range of exercises that assist trunk and pelvic movement; this may include flexing the hips fully up and down, ‘running the legs’, trunk rotation and active trunk flexion.

How much fibre is enough?

Infants

• 0-6 months – No recommendation has been set
• 7-12 months – No recommendation has been set

Children and adolescents

• 1-3 yr – 14g/day
• 4–8 yr – 18g/day
• 9-13 yr (Girls) – 20g/day
• 0-13 yr (Boys) – 24g/day
• 14-25 yr (Girls) – 22g/day
• 14-25 yr (Boys – 28g/day

Toileting

Ask your occupational therapist how to personalize a toileting program for your child. The following principles can be applied:

• Maintain a regular toileting schedule that includes sufficient time for your child to sit on the toilet (up to 10 minutes).
• For many children, the bowel is activated by eating or sitting in water. 15 minutes after a meal or straight after the bath can be a good time to encourage toileting.
• To optimize balance on the toilet and assist with adequate muscle contraction and sphincter release, children should be seated on a toilet or potty with an appropriately sized seat (reducer rings that fit under the normal toilet seat are stable). They should also have their feet supported (e.g on a small step or stool).
• For children with balance difficulties, a rail to hold onto will keep them more secure and allow them to concentrate on their toileting.
• As much as possible, children should sit with their backs straight and leaning slightly forwards. Some children need to be taught to push and require verbal prompts to “squeeze the muscles in their tummies”.

Medications

• Sometimes children with CP will require medication to assist with maintaining regular bowel habits.
• Talk to your doctor to find out if medication may be suitable for your child.

Fibre content of common foods

Breads and cereals	Serving size	Fibre (grams)
Wholemeal bread	30g/1 slice	2.0
White bread	28g/1 slice	1.0
White high-fibre bread	28g/1 slice	1.5
Pita bread	60g	2.5
Fruit bread	30g/1 slice	1.0
Weetbix	30g/2 biscuits	3.5
Sultana Bran	1 cup	2.9
Oats – raw	½ cup raw	4.0
Just Right	1/2 cup	2.0
Cornflakes	30g/1 cup	0
Rice Bubbles	30g/1 cup	0.5
White rice	1 cup cooked	1.5
Brown rice	1 cup cooked	3.0
White pasta	1 cup cooked	3.0
Wholemeal pasta	1 cup cooked	8.5
Shredded wheatmeal	2 biscuits	2.0
Milk arrowroots	2 biscuits	0.5
Saos	3 biscuits	0.5
Wholemeal crackers	6 biscuits	2.0
Rice cakes	2 Cakes	0.5

 

Fruit and vegetables	Serving size	Fibre (grams)
Apple	1 medium	3.0
Orange	1 medium	3.5
Banana	1 small	2.5
Sultanas	30g	1.5
Dried Apricot	25g/6 small	2.5
Canned Fruit	1 cup diced	3.5
Fruit snack pack e.g. pears	140g	2.9
Potato, no skin	1 medium	1.0
Potato, skin	1 medium	1.7
Carrots, cooked	½ cup	3.0
Green Beans, cooked	100g	2.5
Pumpkin, cooked	85g	1.5
Salad	1 cup	1-2
Baked Beans	220g /½ can	10.5
Peanut Paste	1 tbsp	2.0