Resources: Autism Fact Sheet – CONSTIPATION
Autism Fact Sheet
Information on signs, symptoms, possible causes and solutions to constipation in autism
This document was written by a parent in an effort to help others save research time. It is not medical advice. The order of the information is not meant to imply any priority. This information will only be a start for many people as it is, by necessity, incomplete.
Constipation doesn’t always look like expected
Constipation is defined as the condition in which bowel movements happen less frequently than is normal for the particular individual, or the stool is small, hard, and/or difficult or painful to pass. Do not focus only on the “small, hard” stool part of this definition. Many kids with autism are constipated and pass liquid stools (diarrhoea) or soft stools. Some kids have bm’s each day, but they are hardish pebbles packed together or they are suffering from low motility or slow transit constipation, meaning that their bm’s could look relatively healthy, but because of the slow motility they are, in fact, suffering from impaction. Some experts believe that one should pass approximately 10 inches of stool each day. Less would mean constipation but one can pass that much stool and still be suffering from constipation or impaction.
What is a ‘bowel impaction’ and how can it be diagnosed?
A bowel impaction can only be reliably diagnosed by an x-ray looking specifically for that problem. It can NOT always or even often be felt because contrary to popular belief, the impacted stool is not always hardened. Some kids who have been shown to be impacted on an x-ray had flat bellies and formed bm’s each day. If a parent has any suspicions at all, it would be prudent to demand an x-ray for the child, if only to rule out impaction.
What does a ‘normal’ bowel movement look like?
The elusive trophy poop: A normal bowel movement should be formed, some shade of brown, shaped like a sausage or banana, and relatively soft. It should be smooth in texture and sink gently down into the water of the toilet.
What causes constipation?
Thyroid problems – hyper and hypothyroidism
Investigate a possible thyroid problem. It is well accepted that a malfunctioning thyroid, specifically hypothyroidism, can cause constipation. Most people have found that medical professionals will not test thoroughly for thyroid function, if they test at all. This article presents a thorough investigation of thyroid function. Thyroid problems are not uncommon in children with autism and are implicated in many other struggles besides constipation.
Lack of movement and exercise
Gut motility can sometimes be improved through exercise. If a child exercises more, particularly high energy activities such as bouncing on a trampoline, this may improve gut motility and help to resolve constipation.
Vagus nerve stimulation
Some experts argue that vagus nerve problems can reduce gut motility. In other words gut motility can sometimes be linked to vagus nerve (dys)function and can be improved by stimulating the vagal tone. Reduced gut motility can increase dysbiosis, which in turn further impairs vagus nerve problems. This vicious circle is why some professionals suggest interventions such as the Nemechek protocol and various dietary approaches such as the Body Ecology Diet. This article offers an ‘introduction to the vagus nerve‘, while this one discusses ways to stimulate the vagus nerve.
Massage for improved gut motility
Gut motility can sometimes be improved through abdominal massage. Here is an introductory article. Preliminary results from published trials indicate that visceral osteopathy massage can be helpful for constipation in children with autism. This treatment can only be carried out by a qualified practitioner.
Lack of hydration
Ensure proper hydration. Increasing water consumption is a commonly offered solution to constipation but would only be pertinent a child was dehydrated. A well hydrated child will not stop being constipated with the addition of more water. Do note that some people recommend against drinking water with a meal as that can lower stomach acid and some children may already suffer from decreased stomach acid, a possible cause of constipation.
Ruling out allergies and food sensitivities
This is complex but research and clinical experience has shown that dietary changes can improve symptoms associated with comorbidities in autism and improve quality of life. Certain foods can be constipating for some people – the list of possible offending foods depends where you look. For example mild and diary products can cause severe constipation in some people, but it is always worthwhile searching different sources of information on this topic, and ruling out possible offending foods. This video does not focus on constipation, but instead gives an introduction to understanding diet in general in autism, including things to consider removing and things to consider adding.
Investigate intestinal yeast as a problem. Yeast overgrowth may help cause constipation. Clinicians and parents report the most effective approach to treating yeast overgrowth is multi-pronged: stopping ‘feeding’ yeast through dietary changes, using antifungals, and repopulating the good bacteria through cultured foods and possibly probiotics while at the same time providing prebiotics for the good bacteria to feed on. Sally Fallon of the Weston A. Price Foundation points out that some cultures like the Inuit had a traditional diet virtually devoid of fibre but were not constipated and she attributes part of this to the consumption of cultured foods such as kefir, kombucha, homemade yogurt, and sauerkraut.
Small Intestinal Bacterial Overgrowth – SIBO
Investigate SIBO as a problem. Research has shown that small intestine bacterial overgrowth may be a common problem in autism, affecting perhaps one-third of children in one study. Some parents have reported great success in addressing health issues by using what is called the Nemechek protocol for SIBO which involves specific fats and the use of a prebiotic fibre called inulin. Breath tests for SIBO are available. Some parents have reported that probiotics for children with SIBO have caused problems.
Rule out mitochondrial dysfunction
Mitochondrial dysfunction and autism are connected. Mitochondrial problems can also result in constipation among many other problems. This article provides an introduction to mitochondrial dysfunction.
Not eating the right size meals
“Grazing” behaviours rather than eating fewer larger meals can mean the bowels are not getting the right signal to empty (the gastrocolic reflex).
Low levels of butyric acid
Check butyric acid levels. Constipation can be a result of low butyric acid. This can be verified by testing the stool. Butyric acid (butyrate) is found in butter and ghee, especially when left at room temperature for longer periods of time, and also cheeses, but can also be supplemented.
Medications and supplements
Some supplements or medications can be constipating. If your child has become recently constipated, do consider the most recent supplements or medications you’ve added. As with foods, it seems that almost all supplements and medications can cause some few kids to become constipated.
Lack of nutrients
Consider adding certain supplements. Readily available supplements such as vitamin C and magnesium can help address constipation for some. Keep in mind that buffered C will not raise stomach acid. Some parents have found that with the addition of amino acids, particularly l-carnitine, a child’s ability to push out the stool is much improved (in all likelihood, gut motility is being improved). Other parents have found that using aloe vera is helpful, George’s is a brand that is tasteless. Some people have found that adding good fats will help resolve constipation. The WAPF recommends a good cod liver oil. Oxypowder® is specifically for constipation and some parents have reported good effects.
The use of enemas and suppositories
Enemas can be useful as a kind of last resort, since most children and parents find them very stressful and too many can cause gut bacteria diminishment. Some parents, on the advice of a doctor, have used enemas for a short period to help deal with impactions. Glycerine suppositories can be purchased at any pharmacy and can help if the child is struggling to pass a hard stool. Some people prefer the glycerine enemas (Babylax). These are considered quite safe; however, some children may find them very stressful, they don’t address the core issue, and therefore they don’t always work.
Polyethylene glycol sachets
One possible solution offered by doctors is Movicol®, Miralax® or Glycolax®. However the usage of polyethylene glycol powder for children has been off-label and concerns have been raised about its use in children with autism.
Dietary fibre and constipation
Fibre can be a double-edged sword for people with constipation and it is important that parents understand how it works. A sudden increase in fibre by using supplements can cause gas and abdominal pain. Also, diets that have too much fibre can reduce the absorption of certain minerals including zinc and calcium, which might be problematic. It is important to note that a consistent amount of daily fibre can be helpful; inconsistent amounts can make problems worse.
There are different types of fibre. Soluble fibre is found mainly in plant cells. Common sources are oat bran, oatmeal, fruit, vegetables, psyllium and supplements like Benefibre®. Soluble fibre will absorb water and act like a gel. It is imperative that if you supplement fibre (as opposed to, for example, eating it in fruit where it comes with its own water supply) you give extra water. If you do not give extra water, the insoluble fibre will absorb water from the intestine and your child will become MORE constipated, not less.
Insoluble fibre comes from the structural parts of plant cell walls. Good sources are wheat bran, the skin of fruit and vegetables, nuts, seeds, and whole grain foods. Insoluble fibre adds bulk to stool and therefore can be helpful in moving the stool out by acting as a kind of a bulky brush.
Often a 50/50 ratio of soluble to insoluble fibre is recommended. Flax seed (you can grind it yourself to avoid it going rancid) is close to this ratio.
Some parents have found that something as simple as prune juice, which is fairly easy to introduce and high in fibre (although it also contains a special sugar that acts as a laxative), is enough to resolve the problem; however, most parents find that resolving constipation is more complex.
Chiropractic and visceral osteopathy
Some parents have reported good success using a chiropractor to deal with constipation. Some children seem to have a signaling problem that chiropractic is reportedly able to deal with. Other children seem to have a lazy ileocecal valve which can be massaged. This massage, which takes only a minute or so and can be learned by a parent, can improve the transit of the stool and prevent it from hardening.
Behavioural approaches to constipation
Encourage your child to go to the toilet as soon as he feels like having a bm. If the child does not feel it, set aside special times during the day for trying. If the child uses a toilet, a small bench under his feet may help him feel comfortable. If the child is in diapers or on the toilet, be sure to give him privacy if he seems to want it. Try to make having a bm as stress-free as possible. If your child has had an impaction, there is a good chance that his colon has been stretched and will take some time to return to normal. It is very important during this period to have your child try to poop regularly as he may not feel the urge as he should. It can take up to a year for full function to return.