Nine-year-old Lucia Caceres' face contorts with effort
as her mother exhorts her to push. No, Lucia isn't contending
for the title of world's youngest mother, she's merely
trying, unsuccessfully, to empty her bowels. Constipation
is hard enough to endure for an adult. But, as Lucia's
mom can attest, failing to poop can be even more uncomfortable
and traumatic for a child. Now, compounding the worry,
comes news that a prolonged bout of constipation can set
a child up for more bathroom difficulties in the future.
Dutch researchers, headed by Dr
F de Lorijn of Emma Children's Hospital in Amsterdam,
have published a paper in the August issue of Archives
of Disease in Childhood documenting that a colonic
transit time � the time it takes waste to move through
the large intestine � that exceeds 100 hours can predict
the success, or more accurately the failure, of bowel-unplugging
treatments.
If the colonic transit time exceeds
100 hours, a child's chances of having constipation
problems a year down the road are high. The study involved
169 consecutive patients (110 boys and 59 girls) with
an average age of 8.5 years who were seen by the Dutch
researchers between 1995 and 2000. All the patients
had less than three bowel movements a week, most of
which were involuntary. The children also had a very
large bowel movement every one to four weeks and had
a mass of feces that could be felt by palpation of the
rectum or abdomen.
The colonic transit time was determined
by x-ray examination when each child first entered the
study. The children were treated in a variety of standard
ways, such as eating foods high in fiber, taking laxatives
and using biofeedback as a behavioural modification
strategy. In exceptional cases, an enema was given to
dislodge the feces quickly. While in treatment and for
some time afterward, each child was encouraged to keep
a diary to record their symptoms.
The frequency of urgent and involuntary
bowel movements was higher in the boys who also had
fewer bowel movements than girls. Colonic transit times
were significantly longer in kids who averaged one or
less bowel movements a week as compared to those who
had more frequent bathroom trips. The ensuing year brought
continued constipational woes for the 22% of children
who had a colonic transit time measured at over 100
hours.
Dr de Lorijn and colleagues were
led to the somewhat dismal conclusion that "the diagnostic
and prognostic role of [colonic transit time] measurements
is limited." More optimistically though, the finding
that a colonic transit time exceeding 100 hours "is
associated with a poor outcome at one year" might prove
to be a helpful guidepost for targeting treatment.
|
