Abstract
Constipation is a common problem for children with disabilities. The inability of children with disabilities to communicate abdominal discomfort or pain with stooling may impair the ability to diagnose constipation. The causes of constipation may vary with the type of disability. The type and degree of disability also has an impact on treatment modalities. Constipation may have many adverse consequences, including behavioral problems, poor feeding, pain, rectal bleeding, the social stigma and emotional stress associated with incontinence, as well as potentially serious problems such as megacolon and bowel obstruction. Identification and treatment of constipation in children with disabilities is, therefore, of high importance.
Constipation and encopresis are common problems in childhood. They account for 3-5% of visits to pediatricians and 11 to 25% of visits to gastroenterologists.1,2 From 16 to 32% of parents are concerned at some time that their child is constipated.2 The rates are even higher for infants and children with disabilities. Seventy-four per cent of children with cerebral palsy have chronic constipation.3 Tse et al. found that more than 50% of children with severe developmental delay had chronic constipation.4 Because of abnormalities of the spinal cord and their impact on ano-rectal function, stooling abnormalities are nearly ubiquitous in children with spina bifida and spinal cord injuries. Constipation is also a frequent complaint among individuals with Down syndrome.5 Providers working with infants and children with developmental disabilities need to monitor carefully for the presence of constipation and be aware of treatment options, particularly during periods of transition that pose a high risk for development of constipation, such as introduction of solid foods, initiation of toilet training, and beginning school. Questions regarding stooling may need to be fairly directive, for not all parents or other caregivers will recognize that a child's stooling pattern is abnormal; nor will they realize that something can or should be done regarding stooling difficulties.