Poop! There It Is!

The Poop. Goodness gracious… the poop. We can’t talk about autism without talking about the poop. At TACA, we hear about it all the time.
“My kid can’t poop.”
“My kid has loose stool.”
“My kid has a distended stomach.”

Even when you don’t realize it is the poop, it is often…. the poop.

Child stops eating? Could be constipation making him feel full.
Child not sleeping? Could be constipation waking him up at night.
Child is aggressive? Could be pain from constipation making him lash out or pathogenic bacteria in the stool causing this.
Child needs deep pressure, especially on the abdomen? Could be needing counterpressure from the gut pain. (This is called posturing.)
Child starts having streaks in their underpants? Hallmark sign of constipation.
Child starts wetting the bed? Could be constipation.
Child’s poop is terribly stinky? You guessed it. Constipation or pathogenic bacterial overgrowth in the stool.

According to this meta-analysis, Children with autism are more than 3.5 times more likely to suffer chronic diarrhea or constipation than are their normally developing peers. So, obviously, this is something that as autism parents, we need to be aware of.

A doctor can order a KUB (an abdominal x-ray) to check the intestines for stool build up or blockages. It can also tell them the location of the built-up stool. If there is an abundance of gas, they can tell you that as well.

I took my child to the pediatric gastroenterologist because she rarely slept, whined constantly, and was posturing. I figured she could not possibly be constipated because she pooped twice daily. They took an x-ray and low and behold, the doctor told me that she has never seen so much stool in a child. She was full of stool “from top to bottom”. I had never been so shocked!

Hopefully, your doctor explains that the child needs to be cleaned out. Old, fermenting stool in the GI tract can cause all kinds of problems. Ask the pediatrician or ped GI how to do a clean out without MiraLAX (Polyethylene glycol 3350). See below for information on why PEG 3350 products are not recommended. Many people use dye-free liquid magnesium citrate found at the drug store for a clean out.

Clean out protocols are different for each child. The idea is to get the child to pass all stool until the stool runs almost clear with no lumps. This should take no longer than a few days and please be sure that you have plenty of electrolytes on board to avoid dehydration. Often you will need an enema or suppository to get things moving if the blockage is down low instead of up high. Talk to your doctor about the best option for your child.

Don’t forget about daily maintenance once the clean out is done or the constipation cycle starts all over again! Once the colon is stretched out for extended periods of time, it will require time to gain its elasticity back.

MiraLAX is polyethylene glycol (PEG) 3350. Polyethylene is the most common form of plastic. When combined with glycol, it makes a liquid. Your prescribing doctor probably didn’t tell you that your child was drinking plastic every day. If that child has a permeable GI lining as many kids with autism do, then the plastic has the potential to cross directly into the bloodstream.

This study showed that PEG inhibited most of the metabolic activities of the fecal flora, and this was shown by decreases in total short-chain fatty acids, butyrate, acetate, and fecal bacteria mass. These short chain fatty acids keep the colon healthy and it is unknown what the outcome will be when PEG is used long-term. Butyrate, in particular, is used for energy metabolism and it has been shown that energy metabolism is a problem in kids with autism.

It is important to make educated decisions. More information on MiraLAX from the FDA here.

There are numerous things that help kids get stool moving. Here are some favorites:

Diet Changes – Dairy, Bananas and nut butters can be very constipating. An elimination diet can help you figure out the child’s triggers.
Magnesium Citrate or Magnesium Oxide (plain Natural Calm and OxyPowder are two favorite magnesium supplements that help.)
Vitamin C (at higher doses, buffered vitamin C causes loose stools)
L-Carnitine (Mitochondrial support can help gut motility)
Lots of filtered water
Digestive enzymes
Aloe

If we know why, then we can start to address the underlying issues.

Fungal overgrowth in the gut. – This is very common in kids with autism. Sugar and simple carbohydrates feed fungus in the gut. Anything from diet changes to medications to herbs can help control fungus.
Mitochondrial dysfunction – Studies are telling us that the majority of kids with autism have some level of mitochondrial dysfunction. Supplements that help enhance mitochondrial function can help gut motility.
Gut Dysbiosis – This is just a fancy way of saying the gut is out of balance. Everyone has good (beneficial) gut flora, bad (pathogenic) gut bacteria and fungus in their guts. That is normal. But it all needs to be in balance. When the bad stuff outweighs the good stuff, then you have a problem.
Hypothyroidism – Basic lab testing can help determine if this is an issue.
Inflammation in the GI tract – This can be due to food intolerances, pathogenic bacteria outweighing the beneficial bacteria and more.
Medication or supplements – There are some supplements and many medications that cause constipation. Iron and some probiotics can constipate.

Loose stool is actually a sign of constipation. This is because only the loose stool can squeeze past the stool that is stuck.
Poop should not be stinky. If it is stinky, it has either been sitting in the GI tract too long or there is pathogenic bacteria causing the stink.
It is not just a matter of pooping daily, you have to poop enough every day. At TACA conferences, they tell parents that you should see 8-10 inches of stool per day. If a child skips a day, then they have that much more stool to expel.
Toilet Training is much easier once you get poop issues sorted out.
It should not take a long time to poop. If it does, that is a sign of a problem.
Sometimes simply eliminating dairy can solve constipation problems.
Bathroom accidents in a toilet trained individual can indicate constipation.

Constipation and diarrhea make our kids miserable and unable to focus on therapy. If you have ever been truly constipated, you know how very painful it is. Some of our kids live this way day in and day out.. and sometimes parents don’t even realize it. (I know I didn’t). Due to an altered sense of sensory perception, often they have an altered sense of pain. And sometimes, our kids have been dealing with this problem for so long, they don’t know they are not supposed to feel pain this way.

Let’s work together to find a way to help our kids get out of this awful cycle of GI pain. TACA is here to help!
For more information, see our website here.
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To find a local TACA chapter near you, see here.
To sign up for a free parent TACA mentor, see here.