OI Issues:
Constipation


Introduction
Constipation is a problem for some people with osteogenesis imperfecta. In the medical literature there are two studies that indicate that children and adults who have OI Type III and pelvic deformity are more likely to have constipation and complaints of abdominal pain (Lee, 1995 and Violas, 2002). Constipation, in medical terms, is a decrease in frequency of stools or bowel movements with hardening of the stool. As a consequence, people with constipation may have feelings of being bloated and having gas but find it difficult to pass stools. Because the stool becomes quite hard, passing it may be uncomfortable and lead to further unwillingness to try, especially in infants and young children. Fecal impaction, or clogging of the bowel with hardened stool, can be a serious complication. Treatment of constipation in people with OI is often challenging.

Causes of Constipation
Constipation can be caused by inadequate dietary fiber, lack of exercise, and dehydration. Colon obstruction and illness are additional causes. Some medications, especially pain medications, can be constipating because they decrease bowel wall motion. Adults with OI and parents of children with OI are encouraged to check with their doctor and/or pharmacist about side effects from their medicines and dietary supplements or for possible drug interactions.

OI may contribute to constipation especially in people with the short stature and pelvic deformity associated with OI Type III. The colon and bowel may be prevented from functioning normally if the hips and pelvis are narrow or deformed. A specific pelvic deformity known as acetabular protrusion is known to affect some people with OI Type III and causes a predisposition to constipation. Diminished mobility and low levels of physical activity also contribute to constipation.
Dehydration is a well-known contributing factor to constipation.

Children with OI who have increased perspiration should be closely monitored so they remain hydrated.

Managing Constipation
Managing constipation usually involves a combination of approaches. It is essential to determine the extent of the problem and develop a plan to correct it.

  • Keep a record of bowel movements, diet and fluid intake. Even when a child appears to be "regular," keeping records about diet, illnesses, exercise and bowel movements will help caregivers figure out if something in particular triggers the problem.
  • Be consistent about diet, exercise and activity and fluids.

Children and adults with OI often respond to diet changes, a change in activity level, and mild home remedies. The primary care doctor should be consulted regarding the appropriateness of “home remedies.” A nutritionist or registered dietician may offer useful suggestions for modifying the diet. If the problem persists, a gastroenterologist may be needed.

  • Treatment choices include the following.
  • Diet and fluids
  • Exercise and activity
  • “Home remedies”
  • Medications

Diet and Fluids
Dietary changes can include the following suggestions.

  • Add fiber to the diet including whole grain breads, whole grain cereals, bran cereals or muffins, and popcorn. Ground beans can be added to other foods. 
  • Increase amount of fruits, fruit juice and vegetables. 
  • Add beans and nuts to the diet. For example; serve chili with beans.
  • Reduce amount of processed foods and refined sugars.
  • Avoid “junk” foods that are high in fat and low in fiber.
  • Include foods such as yogurt with active cultures that contain the bacteria lactobacillus acidophilus.
  • Limit soft drinks and drinks containing caffeine such as colas or tea. 
  • Drink water throughout the day.

Strive for a diet that keeps the stool soft. Too much fiber has the secondary effect of creating too much bulk for someone with a connective tissue disorder. This can put pressure on the rectum. Pressure, plus the lax or elastic muscles seen in the pelvic floor of a person with OI, inactivity, too much prolonged sitting, and chronic constipation can lead to a more serious problem called rectal prolapse.

Exercise and Activity
Adding exercise and physical activity can help prevent and relieve constipation. Exercise helps move digested food through the intestines. Infants, children and adults who sit, recline, or use a wheelchair require regular position changes. People should consult with their primary care doctor and physical therapist about beneficial exercises that suit their particular needs and abilities. For example, infants benefit from water play that encourages them to kick. Children and adults can benefit from swimming, walking or bicycling.

Home Remedies
Home remedies can include:

  • Karo syrup
  • Prune juice mixed with a good quality apple juice or applesauce to make it more palatable.
  • Allowing enough time on the toilet. Some physicians suggests 10-15 minutes at least twice a day.
  • Enemas should only be used with a physician’s recommendation.

Medications
For some children, regular medication or even a prescription laxative may be necessary. Use of medication, whether prescription or over-the-counter, must be discussed with your physician. Children on a medication need to be carefully monitored. Taking a medication too often can reduce its effectiveness or aggravate negative side effects.

Medications can include:

  • Suppositories
  • Mineral oil
  • Stool softeners
  • Laxatives such as Senokote®
  • Prescription laxatives such as Miralax®

Confer with the doctor about all treatment options, including “home remedies.” Persistent, painful constipation should not be ignored, and a referral to a gastroenterologist may be required.

Staying well hydrated, eating a healthy diet and increasing exercise can reduce the frequency of constipation in children and adults who have OI.

 

References
Lee JH, Gamble JG, Moore RE, Rinsky LA. Gastrointestinal Problems in Patients Who Have Type III Osteogenesis Imperfecta. The Journal of Bone and Joint Surgery, 1995, Sep; 77: 1352-6.

Violas P, Fassier F, Hamdy R, Duhaime M, Glorieux FH. Acetabular Protrusion in Osteogenesis Imperfecta. Journal of Pediatric Orthopedics, 2002, Sep-Oct; 22: 622-5.

Web site: The Children’s Hospital of Philadelphia http://www.chop.edu/.

 


For more information about osteogenesis imperfecta contact:

Osteogenesis Imperfecta Foundation
804 W. Diamond Avenue, Suite 210, Gaithersburg, MD 20878
Tel: 800-981-BONE (free of charge) or 301-947-0083
Fax: 301-947-0456
Internet:
www.oif.org
E-mail: bonelink@oif.org 


This fact sheet was prepared by the Osteogenesis Imperfecta Foundation with assistance from Dr. Horacio Plotkin, pediatrician, Children’s Hospital, Omaha, NE.

 

The National Institutes of Health
Osteoporosis and Related Bone Diseases ~ National Resource Center
assisted in the preparation of this publication.

  

Revised 12/02/05



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