Children and young people with physical disability who are immobile or have restricted mobility can experience constipation and/or an inability to empty their bowels so that their body can’t get rid of waste as it needs to.

How does the digestive system work?

A healthy digestive system works to move food and liquid through your GI (gastrointestinal) tract, it gets broken up into smaller parts as it moves through. Once foods are broken into small enough parts, your body can absorb and move the nutrients to where they are needed to fuel your body. The waste products of digestion are excreted when you go to the toilet. Nerves and hormones help control this digestive process.

How does food move through the GI tract?

Food moves through a person’s GI tract by a process called peristalsis. The large, hollow organs of the GI tract contain a layer of muscle that enables their walls to move. The muscle behind the food contracts and squeezes the food forward, while the muscle in front of the food relaxes to allow the food to pass through. Each of the organs in the GI tract plays a vital role in healthy digestion, here’s how:

Mouth - Food starts to move through your GI tract when you eat. When you swallow, your tongue pushes the food into your throat. A small flap of tissue, called the epiglottis, folds over your windpipe to prevent choking and the food passes into your oesophagus (food pipe).  Your salivary glands make saliva, a digestive juice, which has an enzyme that begins to break down starches and moistens food so it moves more easily through the oesophagus into your stomach.

Oesophagus - Once you begin swallowing, the process becomes automatic. Your brain signals the muscles of the oesophagus and peristalsis begins.

Lower oesophageal sphincter (muscle) - When food reaches the end of your oesophagus, a ringlike muscle — called the lower oesophageal sphincter — relaxes and lets food pass into your stomach. This sphincter usually stays closed to keep what’s in your stomach from flowing back into your oesophagus.

Stomach - After food enters your stomach, the stomach muscles mix the food and liquid with digestive juices. Glands in your stomach lining make stomach acid and enzymes that break down food. The stomach slowly empties its contents into your small intestine. 

Liver - Your liver makes bile that helps digest fats and some vitamins. Bile ducts carry bile from your liver to your gallbladder for storage, or to the small intestine for use.

Gallbladder - Your gallbladder stores bile between meals. When you eat, your gallbladder squeezes bile through the bile ducts into your small intestine.

Small intestine - Your small intestine makes digestive juice, which mix with bile and pancreatic juice to complete the breakdown of proteins, carbohydrates and fats. Bacteria in your small intestine make some of the enzymes you need to digest carbohydrates. Your small intestine moves water from your bloodstream into your GI tract to help break down food.

Large intestine - Waste products from the digestive process including undigested parts of food, fluid, and older cells from the lining of your GI tract pass into the large intestine. The large intestine absorbs water and changes the waste from liquid into stool. Peristalsis helps move the stool into your rectum.

Rectum – This is the lower end of your large intestine, it stores stools until it you push them out during a bowel movement.

When any of the muscles or organs involved in digestion aren’t working properly, children can experience bowel issues including constipation and need some help.

Why do children experience bowel issues?

The process of digesting the food that children need is complex and there are a number of reasons why this process may not be working and a child may suffer from constipation. Here are some examples:

• Damage to the spinal cord (due to infection, inflammation, compression, genetic issue etc.) impacts bowel function
• Short bowel syndrome
• A decrease in muscle strength and coordination
• As a side effect of medications that they are taking
• Problems with intestinal function

General strategies for preventing and managing constipation

Diet, fluid and exercise

• For children and adolescents, a dietician should assess and recommend the right amount of dietary fibre that your child should consume
• The general recommendation for fluid intake for children and adolescents is 50-60mL per kilogram of their weight, per day. This can be water, juice or cordial, plus fluids from other sources (such as fruit).
• For children with spinal cord injury, the fluid intake required to help prevent constipation must be balanced with the amount needed for bladder management.
• Encourage regular exercise within your child’s ability. If your child has mobility impairments they may benefit from exercises such as pelvis tilt, low trunk rotation and single leg lifts.

Toileting activities

• Establish a toileting routine to help prompt your child that it is time to go. If they eat or drink around 30 minutes before toilet time, this can help to stimulate the bowel reflex.
• Your child’s physical position on the toilet can help them to go. Encourage them to sit upright with both feet supported (such as on a footstool), lean forward and rest their elbows on their knees.
• If your child isn’t able to sit, position them lying on their left side while bending their knees and moving the legs toward the abdomen.
• Help your child to feel relaxed and encourage them to not hold their breath when trying to go.

Medication

• Laxatives are useful for the short-term treatment of constipation. They can only be prescribed for long-term management of constipation by medical practitioners or nurse practitioners.

Education

• An appropriately qualified health professional, such as a Xavier nurse can provide education on how to support your child to prevent and treat constipation.

We’re here to help

Our team of qualified Registered Nurses and Enrolled Nurses support children with disability and their families to prevent and treat constipation and other bowel issues. We’re here to help simply call us on 1800 XAVIER or email intake@xavier.org.au