This newsletter is going to focus on a topic many of you may be familiar with… faecal retention and constipation.
The GI Tract
A normally functioning gastrointestinal (GI) tract is an often overlooked important part of good health. The GI tract is responsible for the digestion and absorption of nutrient and fluid as well as protection from absorption of harmful agents. When the GI tract is not well, we can feel quite miserable with stomachache, vomiting, diarrhea or other symptoms, such as behavioral changes or problem behaviors. When healthy it seems to almost go unnoticed. However, it may not call attention to itself even when it is not functioning.
Elimination of Stools
The body depends on regular stooling to help eliminate the normal daily waste products of the body and to allow undesirable ingested items to pass through the body unabsorbed. Regular elimination also helps rid the intestines of undesirable microbes (such as bacteria, viruses, parasites and yeast). Fixing any underlying problems and restoration of normal stooling are very important in helping the body function optimally.
Constipation is best defined as difficulty in passing stools, which leads to incomplete and irregular elimination of stools. It is a common problem among many people; however it occurs in greater frequency in patients with neurodevelopmental disorders, food allergies and as a side effect of certain medications. Passing a painful stool reinforces the desire to retain stool to prevent pain, which causes the problem to get worse.
Faecal retention is best thought of as an incomplete elimination of stool and a tendency to retain excessive stool in the colon or large intestine. It may be a problem even if the stools are not hard to pass, painful or passed daily. Typically with faecal retention one or more large stools are passed periodically to catch up the accumulation or retained stool (i.e. a large stool that plugs the toilet); however, the retention cycle tends to repeat itself without proper treatment.
A diagnosis of constipation and/or faecal retention can be made clinically by history, physical exam and/or by a noninvasive KUB x-ray (kidney, urethra, and bladder) that can assess the degree of retained stool. A KUB can also be used during treatment to assess the degree of cleanout of retained faecal material.
Treatment will depend on the severity of the problem and may require the use of an enema or suppository to assist in the elimination of hard impacted stool. Unfortunately, there is no quick fix and constant vigilance is required to prevent reaccumulation of stool. Restoration of normal stooling is typically associated with improvements of general wellness, behavior and gastrointestinal problems. In fact, a recurrence of old symptoms or behaviors may indicate the return of constipation or faecal retention.
Types of Treatment
The clean out phase → to achieve complete elimination of retained and/or hard stool (in some cases repeating the KUB will be necessary to ensure clean out has been achieved)
The more extensive the amount of stool retained, the more that will need to be done to restore normal passage of stool. With distention of the lower colon called the rectum or sigmoid colon, an enema or suppository may be necessary to help get the stool out. Also, if a repeat KUB is recommended then continue the clean out regimen until it is known that clean out has occurred. The most common reason for continued problems is to not achieve clean out.
The maintenance phase → this is the supportive care needed to achieve regular, daily stooling without the symptoms or behaviors of constipation and faecal retention.
The goals of maintenance are to maintain normal stooling without the symptoms or behaviors associated with constipation or faecal retention and to recognize when the problems are recurring. Early recognition of a constipated stool or a tendency to retain stool will lead to an early remedy.
In our next newsletter, I will be discussing two products which many of our patients are using to treat faecal retention (in both the clean out phase and maintenance phase) and seeing great results might I add. These products are called; i) Polylax and ii) Magnesium Hydroxide.