Bowel problems in children can occur for many different reasons. Some are related to a specific diagnosis, like Spina Bifida or Anorectal Malformation. Some are more diffuse and differ over time, like constipation or tummy cramps. We tried to map some of the concepts for you!
First of all you can organize the conditions in ‘neurogenic bowel’ and ‘functional bowel’, even if there are exceptions from these as well.
Spinal Cord Injury
Spinal cord injury (SCI) in children is quite rare under the age of 15 and represents less than 4% of the whole group. SCI in children also differs compared to SCI in adults. For example, neurological recovery is thought to be slightly better, and scoliosis development is more commonly seen in children.
Children with SCI often have issues with bladder and bowel.
Spina bifida is a birth defect. It occurs when the bones of the spine don't form properly around part of the baby's spinal cord.
There are three main types: spina bifida occulta, meningocele, and myelomeningocele. Myelomeningocele, also known as open spina bifida, is the most severe form.
Children with Spina Bifida have little or no control over the anal sphincter, which causes faecal incontinence in around 13-71% of the children. Due to lack of nerve supply, the stool also moves much slower through the colon. This means that more water is removed from the stool, making it harder which in turn leads to constipation for the child.
Functional bowel problems constitute almost half of the visits to the paediatric gastroenterologist. Pain, constipation, diarrhoea and faecal incontinence are common reasons for seeing a doctor.
Childhood constipation is very common in younger children. Around a third of the children under the age of nine suffer from it now and then. In children, constipation is classified as less than 3 poos a week. There can be many reasons for constipation: Avoiding or fear of going to the toilet, fluid intake and/or too little fibre in the diet, emotional upset and taking medication, are some examples.
A child who is constipated may soil his or her underpants. Soiling happens when liquid stool from farther up in the bowel seeps past the hard stool in the rectum and leaks out. Soiling is a sign of faecal incontinence. The child cannot control the liquid stool and may not even know it has passed.
Anorectal malformations means that anus* and rectum* haven’t developed properly during the pregnancy. It occurs quite early in the fetal development. It is a rare problem that affects slightly more boys than girls (around 1 in 5000 babies).
Anorectal malformations is a collective term for several types of anomalies:
- The anal passage may be narrow or misplaced.
- The rectum may not connect to the anus.
- A membrane may be present over the anal opening.
- The rectum may connect to part of the urinary tract or the reproductive system through a passage called a fistula, and there is no anal opening.
*Anus: The opening at the end of the large intestine through which stool passes.
*Rectum: The area of the large intestine just above the anus.
Hirschsprung's disease is a condition that affects the large intestine and causes problems with passing stool. Children with Hirschsprung's disease are missing the nerve cells in the wall of their colon or rectum. These cells are responsible for the normal wave-like motion of the bowel. When they are missing the stool stops and causes constipation. The length of affected bowel varies.
Hirschsprung's disease is a congenital disease. That means a person is born with it. The disease may also be hereditary, which means a parent can pass it to a child.
All bowel problems caused by the above conditions can be treated in various ways, but common for all of them are that transanal irrigation might be a good option. Ask your doctor for advice!