Disclaimer [when I was young, and still had a soul and a life, poo was not a topic of conversation I enjoyed. It is safe to say I avoided it most of the time. However once I became a parent it was a favourite. How was Michael pooing? How often? What did it look like? What consistency and smell? This fascination has continued, partially due to his many and varied tummy problems. So yes, this post is soon after Christmas when many of us will have tummy problems due to overeating, and might be able to sympathise. This is a post about poo. Read at your own risk. Unless you’re a parent yourself. Then I know you totally get it.]]
Our weeks with Michael revolve entirely around his sleep, his food, and his therapy. The problem with having a full schedule is that if anything throws it off (like bad sleep) everything falls apart. Now that Michael is over his cold, I thought everything would go back to normal. Well, nothing is ever normal in this family! Life for us is just a series of problems for us to solve. Last week, it was the fact that he had a blocked nose and couldn’t sleep. This week, it’s because he is constipated and can’t sleep. Some days, he also has diarrhea. And (you guessed it!) can’t sleep.
The latest form of discomfort for him has been tummy issues. The breastfeeding really helped in the first year and a half. Actually, it probably helped too much, because he used to poo ten times a day. Really ten, I counted.
Since he’s been on solids though, especially the last year and a half, his tummy has gotten worse. Mostly we have been battling constipation, but sometimes diarrhea and gastro come into it as well. What makes it worse is that I never know if it is diet related, IBS related, or just Michael-ate-an-insect-off-the-floor related. Tummy issues are hardly surprising in a person that licks the walls at least three times a day. Although on the bright side, my doctor friends tell me he’ll get a killer immune system out of it.
Michael has managed in the last week, to average about eight hours of sleep per day. He actually needs about eleven, so this is to put it mildly, not good. First, he was constipated. Then, he had diarrhea for about 24 hours. Now, he is constipated again and his tummy is still probably sore from the diarrhea. And some days he manages the impressive feat of being constipated in the morning and having diarrhea in the afternoon. Then back again.
So while I’ve been dealing with that problem, I’ve decided to research the links between gut problems and autism. So here are some interesting things I’ve discovered:
Gastrointestinal (GI) problems are very common in children with autism
I have often wondered why Michael insists on getting every single co-morbid condition in autism. Can’t he miss out just a couple? As a special favour to me? Nope, he’s got the ADHD, the anxiety (possibly, I think), the cognitive impairment, the sensory issues, the communication issues, the sleep issues, and of course the gut issues. Alright, so there’s a couple of pretty bad ones I haven’t noticed yet (fingers crossed, knocking on wood, etc etc) and I won’t even name them just in case. But most of the conditions he has covered.
So gut conditions in autism can range from constipation, to diarrhea, to inflammatory bowel conditions. Children with autism are 3.5 times (this number may be higher!) more likely to suffer chronic diarrhea or constipation than typically developing peers. Some researchers have found a strong link between gut issues and severity of autism in children (although it must be noted these findings have not been replicated).
In one study of 960 children, those with frequent abdominal pain, gaseousness, diarrhea, constipation or pain on stooling scored worse on Irritability, Social Withdrawal, Stereotypy, and Hyperactivity compared with children having no frequent GI symptoms.
Conditions of the central nervous system – such as multiple sclerosis, Parkinson’s disease or stroke are associated with an increased susceptibility to constipation. So it does not seem to be limited to autism. And it may partially be explained by the food selectivity so often displayed by children on the spectrum.
For a toddler to have constipation is the most normal thing in the world. I mean, have you seen what they eat? But if constipation lasts for two weeks or more, it becomes chronic. Michael’s constipation has been there, on and off, for absolutely months. So it is very much chronic.
Michael poos twice a day. I know that doesn’t sound like he has constipation but it’s about how hard the poo is, not how often it is passed. Michael’s isn’t severe. So he doesn’t pass hard, pellet like stools. But they are on the ‘hard’ side and make him uncomfortable so they still meet the definition.
Each time it is very difficult for him, and he screams and cries a lot. He gets cramps as well, and I can always tell that he has tummy issues by his pattern of crying. He might be totally happy and fine, and then suddenly arch his back and scream. Then be fine again. Then scream again. It’s an awful and painful experience for both of us.
Causes of Chronic Constipation
The first time Michael was constipated, when he was just over two years old, the cause was definitely his diet. It was the thing that encouraged me to put in our food program. At the time, he drank soy milk and ate bread. And that was it. Honestly, that kind of diet would make anyone constipated. Often, he wouldn’t poo for two or three days and then could only do it in the bath.
Then his diet improved. And it became better – as I’ve mentioned, he poos twice a day. So that’s a positive. It is not as ‘hard’ either as it used to be. And of course with that comes improved sleep and better behaviour.
But he would still get constipated. Despite eating five servings of veggies every day, two servings of fruit, lots of whole grains (although I avoided rice like the plague because boy did that make things worse!) he still had a lot of trouble pooping. I avoided bananas, dairy he was allergic to anyway, and tried to have as much non-meat related iron in his diet as possible. He had berries for breakfast every day. He should have had no problems at all! It only got better when I introduced dried apricots three times a day. And it’s still far from perfect.
Non Diet Causes of Constipation
Research has shown that the gut problems experienced by many people on the spectrum are not just caused by diet. Other contributors can include anatomic, neurological or metabolic problems or abnormal gut motility (a sluggish intestinal tract). Medical tests are needed to identify such underlying causes. Treatments can include both medical and behavioral interventions.
Medications may include soluble fiber and laxatives such as mineral oil, magnesium hydroxide or sorbitol.
And then there’s the diarrhea
Not happy just with constipation, Michael is also prone to diarrhea. He does not have chronic diarrhea (I’ll be thankful for small mercies). He just seems to get it every couple of days, straight after being constipated. It is probably part of his IBS. Occasionally it is also caused by gastro or other childhood disease – in which case it is over in a few days. But many children on the spectrum do have chronic diarrhea and it can be very painful and unpleasant.
Chronic diarrhea can be caused by intestinal infections, various allergies or intolerances (like gluten), immune dysfunction and inflammatory bowel disease. Treatments for it can include special diets (for example gluten free), sometimes medications and rarely, surgery.
Gastroesophageal reflux disease (GERD)
GERD results when the muscle between the stomach and esophagus (food pipe) is lax. This allows partially digested food or liquid mixed with stomach acid to move up out of the stomach.
Michael doesn’t suffer from this to a great extent, but it definitely happens sometimes. I can see that he vomits up a bit of food and then swallows it again. It doesn’t seem to bother him, luckily. But he does hate lying on his back, get hoarse sometimes, and claw at his throat and I think that they might be symptoms of GERD. Unfortunately he refuses to elevate his head while he’s asleep and doesn’t like pillows so there’s not much I can do about it – he does prefer to sleep on his stomach, which seems to make him more comfortable.
Casein and Gluten-Free Diets
There is a lot of anecdotal evidence for casein and gluten-free diets. I personally hate anecdotal evidence, and prefer the actual evidence kind of evidence. This is because with irritable bowel type problems, and with behavioural symptoms of autism, there is a massive placebo effect. It can be up to 70%. That means that you can give your child a sugar tablet and as long as you think it’s ‘medicine’ and they think it’s ‘medicine’ you will think it is working 70% of the time. This is especially so with high functioning kids who can modify their own behaviour in line with what they think the medication/special diet is trying to achieve. With low functioning kids the placebo effect is much lower, but it can still work on parents.
The main problem with these diets is how hard they are to maintain. Gluten remains in the bloodstream for many months after last consumed. It is extremely difficult to exclude completely and is the reason why there is no scientific evidence to support its effectiveness. Families just can’t keep to it, so it can’t be studied.
All I can advise if you do try it, is see if there is a history of gluten intolerance etc in the family already. And do it safely, with the help of a dietitian, who can suggest foods to add instead of the ones excluded.
So all I can do for now, is keep at the healthy diet, encourage lots of fveggies, fresh and dried fruit, water drinking and exercise. And keep an eye out on those gluten free diet studies!