Some facts about CP and constipation:
- Up to 75% of people with cerebral palsy report problems with constipation.
- Constipation can cause:
Constipation in typically developing children is defined as having at least two of the following conditions, at least once a week for a month:
- Two or fewer bowel movements in the toilet per week
- At least 1 episode of bowel incontinence per week
- History of standing or sitting to prevent a bowel movement or withholding stools
- History of painful or hard bowel movements
- Presence of a large fecal (stool) mass in the rectum
- History of large-diameter stools that may obstruct the toilet
For people with CP it’s important to reach out to your professional team if stools are painful to pass or there are other symptoms such as abdominal pain, vomiting AND the person or family is worried about it.
Additional causes of constipation in cerebral palsy (this is not an exhaustive list):
In patients with CP, there is probably some alteration in the function of the muscles of the GI tract, just as there is with the muscles of the arms and legs.
Ideas for Managing Cerebral Palsy and Constipation
First, address the individual’s bathroom needs:
- A person needs to be able to brace their feet in order to use the abdominal muscles to pass stool. Put something in front of the toilet if their legs don’t reach.
- If the person is small and they feel like they will fall through the toilet seat, a “ring reducer” may be helpful.
- If the person has difficulty with balancing themselves, a toileting chair can be helpful with different support options. These require a prescription and sometimes will be paid for by insurance.
Second, improve the likelihood of a good bowel movement:
- Increase fiber and fluid in the diet as able
- Increase physical activity, as able.
- Standing frames are often helpful for improving bowel motility.
- A person’s system is primed to have a bowel movement after eating- this is called the gastrocolic reflex; essentially the body wants to make room for the meal. Take advantage of this by encouraging the person to try and use the bathroom shortly after eating, at least once a day, remaining seated for at least 5-10 minutes.
Third, medications may be helpful.
*Always talk with your medical team first before starting any new medications.
Primary Issues with Constipation
There are three primary issues that often lead to or worsen constipation. A person may have one, two, or all of these problems, and they are treated differently. Again consult with your doctor/s before starting a new medication–even over the counter:
- Stool is too hard
- Stool is not moving well through the intestines
- Stool cannot be expelled from the rectum
Stool is too hard
If the stool is too hard, a softener is needed. There is a rating scale for this called the Bristol stool scale, which can be used to track progress. Generally, you want the stool to be formed but not hard.
Stool softeners include:
- Polyethylene glycol (brand name Miralax and others): this is most often used because it is usually well tolerated, and the dose is easily adjustable. It is a powder mixed into water or juice, and that liquid becomes nonabsorbable, making the stool softer.
- Lactulose (brand name Enulose and others): this is a nonabsorbable sugar. Some people find it too sweet to take by mouth, but it can also be given by feeding tube.
- Docusate (brand name Colace and others): allows more water to stay in the stool. Can be given by liquid or pill.
Stool is not moving well through the intestines
If the stool does not travel well through the intestines, a laxative is needed to improve transit. This is often added if the stool is soft, but just not moving forward well.
- Senna (brand name Senokot and others): stimulates movement of stool through the intestines.
- Bisacodyl (brand name Dulcolax and others): stimulates movement of stool through the intestines.
If the stool is soft and gets through the intestines, but can’t get out of the rectum, suppositories or enemas can be used to evacuate the rectum. The rectum’s job is to hold the stool until it is time to go, and in chronic constipation, it can get very large. The larger it gets, the weaker the muscle gets.
Stool cannot be expelled from the rectum
Keeping the rectum empty is important for any bowel regimen. Most bowel problems can be solved with the above interventions, but in some cases a GI consultation may be necessary to look for other problems with bowel motility.
Consult with your pediatrician and perhaps a dietician about creating or enhancing your or your child’s diet to support regular bowel habits.
The information from this page appears in our free and downloadable cerebral palsy tool kit.
This content was edited by Garey Noritz, MD, an internist and pediatrician at Nationwide Children’s Hospital.