Constipation in mentally handicapped children

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The incidence of constipation was around 61% in a large cohort of mentally handicapped children in Dutch and Belgian institutions. Constipation was defined as bowel movements less than 3 times a week. Eighty-eight per cent of the constipated, mentally handicapped, children used laxatives, in comparison to 40% of constipated controls whose constipation was easily controlled. A significant correlation was found between non-ambulancy, cerebral palsy, use of anticonvulsive medication or benzodiazepines on the one hand and use of H2-receptor antagonists or proton pump inhibitors on the other. Also, an IQ of less than 50 correlated with food refusal, while there was no correlation with age, gender, use of cisapride, motilium, untreated GER disease or vomiting. Laxatives used were contact laxatives in 45%, and osmotic agents such as lactulose and enemas in 14%. Manual evacuation of feces was necessary in 7% of patients. In patients with cerebral palsy, anal sphincter pressures were normal. Rectal sensation was reduced and rectal size was increased, possibly contributing to the constipation so commonly seen in these children. Cisapride did not influence colonic transit time, but slightly and non-significantly increased the frequency of defecation from 2.5 to four times weekly. Thus, in summary, constipation in mentally handicapped children is frequently encountered, but seems to respond to laxative treatment without major sequelae.26,27

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Constipation Prescription

Constipation Prescription

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