Constipation in Special Needs
Constipation in special needs individuals is not only common but can give rise to their own challenges. Understanding the root cause of constipation in special needs children can be difficult to uncover, however, I hope in this blog post it will give you strategies to figure out the best treatment.
First, it would be best to determine what an ideal bowel movement should be? An ideal bowel movement is when a person has an easy passing bowel movement that is solid and smooth in form, one to three times a day. It is important to note that bowel movements should be daily. Signs and symptoms of constipation include:
- An uncomfortable amount of gas and bloating in the abdomen
- Cramping and or discomfort in the abdominal region
- Going more than two days without a bowel movement for two weeks or more
- Having a lumpy or hard stool
- Needing to strain to have a bowel movement
- A feeling of not fully evacuating the bowels
Constipation in special needs children can often lead to an increase in problem behavior, as it can be difficult for the child to express the discomfort of being constipated. In addition, when constipation becomes chronic, there are several things that can negatively impact the person. First off, one avenue that the body eliminated toxins is by having daily bowel movements. When constipation goes on for days, weeks, months, and even years the toxic load of the body becomes elevated. That alone will cause issues with digestion, mood, and behavior. The next issues that will arise from chronic constipation, is the toxins start to cause inflammation in the gut lining. When the gut lining is inflamed, we begin to see a decreased production of serotonin (the “happy/feel good” neurotransmitter) and dopamine (the “pleasure/contentment” neurotransmitter). We also begin to see a decrease in active thyroid hormone production (T3-hormone), which will further lead to more constipation, depression, fatigue, dry skin, weight gain, and impaired memory. It’s vitally important to help resolve constipation to help the person detox better, make optimal amounts of neurotransmitters and hormones, and to be in complete comfort with their digestion.
There are immediate steps you can take to start managing constipation in special needs right now. In addition, there is testing that should be taken to investigate if something deeper is happening in the bowels that could be causing constipation.
Steps to take right now to resolve constipation in special needs individuals.
- Hydration with Water and Electrolytes.
Water intake should be half an ounce to one ounce per pound of body weight. For example, a 100 lb person should drink between 50 to 100 ounces of water. Aim for the higher end of this person is active, sweating often (through activity or weather-related), or chronically constipated.
Tips to help increase water intake include using a double-walled water flask to keep water cold for up to 24 hours, as cold water can sometimes be more enticing to drink.
Infuse water with strawberries, citrus, cucumbers, mint, or melon pieces.
Electrolytes are important in helping pull water into the bowels and tissues of the body. However, avoid the popular sports drinks which often have artificial flavors, dyes, and sugars. Instead, opt for coconut water, which has all the electrolytes the body needs to rehydrate as well as a moderate amount of sugar to help pull those electrolytes into the tissues. However, due to the sugar content of coconut water, keep intake to 8-16 ounces a day.
- Increase Fiber Intake.
It’s important to slowly increase fiber intake, as it can cause abdominal discomfort if the fiber is increased dramatically. Consider adding one serving of fruit or vegetable to current diet and increase by ½ a serving each week, while still maintain a high-water intake.
Increase fruit and vegetable intake. Make a fruit salad to snack on. Serve raw sliced vegetables and salads with Primal Kitchen® salad dressings. Roast the vegetables to bring out their natural sweetness. Add in organic fruit & vegetable squeeze pouches. Add in smoothies that have fruits and vegetables blended in them.
Add chia, ground flaxseed, or psyllium husk to 4-6 ounces of water, organic apple juice, or prune juice to hydrate the seeds. Drink as is or add to smoothies.
- Increase Healthy Fat Intake.
Healthy fats help lubricate the bowels and will help stool move along easier. It’s important to avoid non-healthy fats, as these types of fats can further the inflammation of the bowels.
Healthy Fats: coconut oil, unrefined olive oil, avocado oil, ghee, avocados, olives, nut butters, and pasture-raised animal fats. Use these fats for cooking, drizzled over vegetables, added to smoothies, make into salad dressing, make into mayonnaise, or make into fat bombs.
Avoid unhealthy fats such as canola, soybean, vegetable, grapeseed, sunflower, safflower, and peanut oils.
- Add in Probiotics.
Probiotics are living beneficial bacteria in the bowels. The bowels (the gut) typically contain three to four pounds of bacteria & yeast. There is some bacteria & yeast that is incredibly important and beneficial to helping a person have regular bowel movements. When beneficial bacteria and yeast are high, we will see lower inflammation in the body, proper production & elimination of neurotransmitters, enough thyroid hormone production, properly metabolize nutrients from foods, increased ability to fight infections, alleviation in food & environmental allergies, alleviate in symptoms of autism and ADD/ADHD, to name a few benefits. It’s important to have a healthy diet, full of vegetables to allow the bacteria to feed and grow. However sometimes with a poor diet, antibiotic use, gut issues, and chronic constipation, the gut can end up growing harmful bacteria and yeast that ends up causing more inflammation and health issues. Adding in a probiotic can help balance the gut bacteria on the beneficial side.
This one or this one are great options. Tip: start with a very small dose. 1/8 of a teaspoon of water, juice, or chia pudding and work up to the recommended dose on the bottle. Starting with the higher dose can sometimes lead to discomfort in the abdominal region and uncomfortable diarrhea.
- Consider Diet Changes
Gluten, dairy, other potential allergens could be contributing to major inflammation in the bowel and undigested food in the bowel. Removing the offending foods can help lower the inflammation levels and help the bowels heal.
- Squatty Potty®
This is a step that goes around the toilet. When sitting on the toilet normally, it creates a bend in the colon, which can make it difficult to push the stool out. When placing feet on a Squatty Potty® or a step stool, this will raise the knees above the hips and straighten out the colon, allowing for easier passing stool.
- More Movement
When the body is sedentary blood flow to the bowels slow down as well. Walking, performing squats, ab exercises, or general aerobic exercise will oxygenate the bowels and flex the abdominal muscles to help create movement in the bowels.
- Massage Therapy
Muscles throughout the body can be tight from poor posture, sedentary life, or over-active movements. This muscle tension puts pressure on the nerves that tell the bowels to move. Having a trained massage therapist work on certain muscles in the body can help create movement in the bowels.
- Coffee Enemas
Enemas in general often help when stool is hard, impacted, or when there is little to no movement. However, it ends up being a short-term fix. However, coffee enemas, that is using room temperature, organic brewed coffee as the solution in an enema can stimulate the nervous system (migrating motor complex) in the bowels to help create more consistent bowel movements. It also has a detoxifying effect, which is especially important if the constipation is chronic. See this website for information on how-to a coffee enema.
Magnesium works on over 300 different enzymatic processes in the body. One such area is the bowels. When magnesium is depleted in the body, bowel movements will be compromised. Adding magnesium, specifically, magnesium citrate is helpful for stimulating the bowels. It’s best to start low and slow with the dose, such as 100 mg and safely work up to 400 mg. Discontinue use when stools become loose and watery.
Senna is an herb that is often used in teas and tablets. This I only recommend as a very temporary solution. Use should not last beyond 4-5 days.
Last, but not least is testing. Constipation in special needs can sometimes be more than just a temporary issue. Often, we see constipation lasting for weeks, months and sometimes years. When this is happening, it critical that testing is done to evaluate the root cause of constipation. Here are a few tests to consider.
Thyroid- when the thyroid hormone is not functioning at it’s best, the bowels will often become less active. Thyroid levels tend to be low or sub-optimal in the special needs population, specifically those with Downs Syndrome. It’s vitally important to have a thyroid panel done and consult with a trained professional to make sure thyroid levels are within the optimal ranges.
Thyroid Panel: TSH, Free T4, Free T3, Reverse T3, Thyroid Peroxidase Antibodies (TPOAb), Thyroglobulin Antibodies (TgAb).
Stool test- A stool test would be helpful to see if there is pathogenic bacteria or yeast that is causing constipation. If so, a gut protocol diet will be needed.
Breathe test- is used to evaluate if SIBO (small intestinal bacterial overgrowth) is occurring in the small bowels. Depending on the type of bacteria growing, constipation could be likely.
Gut Protocol- using results from a stool test and or breathe test, you and a trained practitioner can put together a gut protocol that will include a modified diet, supplements, exercises, and strategies to get to the root of constipation in your child with special needs.
When treating constipation in special needs children, start at the beginning of this list, however, if constipation is chronic, perform testing as soon as possible and work with practitioners skilled in working with the special needs population. To reach a practitioner about constipation in special needs or other health concerns, contact us here.
How-to Coffee Enema