Thursday, June 17, 2010

Obstipation, What is it?

Simply put it is a condition where the bowel never fully empties out. Unlike constipation, obstipation develops over a matter of many months many times at least a year. Why isn’t it observed from the onset to be prevented? Unlike constipation a person may not feel like they are not cleaning out, and the stools do not always look hard, but remain normal in color and size until total obstipation occurs, at which time the person will have a stomach ache that is sporadic, and painful movements.

Numerous factors can cause this condition, the first thing in a child is they want to determine if right after birth if they passed the meconium, the tarry stool plugs. With Selena now we do not know for sure and have to assume she did since she was over due and had already had her bowel movement in uterus. This is not to say that she did pass the meconium though. Sometimes if they do not pass these little plugs, usually two of them, these will create a partial blockage that over time leads to obsitpation.

Another aspect to this condition is that the rectal wall did not develop correctly. Some babies are born where the rectum is not attached at all, or in many cases not attached properly, a mere birth defect. There are numerous other factors, truly too many to list, but these are the ones that we are focused on now.

It appears more logical in Selena’s case though to be a genetic factor, since there are many in my family who have suffered from chronic constipation, or who have IBS. Many people have this condition and do not even know it. It is a condition where the digestive system has a hard time breaking down the food we digest in a proper manner, and in the same sense the intestines do not absorb enough fluid to do their job properly. The older a child gets and the more foods, well solid foods they begin to eat with a condition like this the more likely they are to experience problems.

Ok, now what do we do? First of all we have to do a cleansing, this is a process of using a mild laxative, in our case Miralax, two times a day for 3 days, repeated again in two weeks. She will take Miralax every day for the next 6 months. At anytime we feel she is becoming obstipated again, we repeat the two time a day routine. Ok now the problem with a laxative, is it tends to break down the vitamins and minerals a body needs. So we have to add these from a multi vitamin.

Diet changes, ok first of all we all know a good fiber diet is needed to keep the digestive system working properly, if you didn’t know this then I guess you do now. In obstipation however, you want to go on a higher then normal fiber diet. Ok, that sounds fairly easy, but wait a minute how many of you new that too much fiber will prevent the body from absorbing the nutrition from food? For an adult a normal fiber diet is 20 – 35 grams a day, a very high fiber diet is 50 – 60 grams a day, now this would be way too much for a child, so now we are looking for the proper balance, a good fiber diet, high enough to help Selena not become obstipated, but at the same time not depleting the nutrients she needs for healthy bones, teeth, and of course maintain the over all health.

I want to emphasize though that without an increase in fluid intake, neither the laxative nor the high fiber diet will work properly. A high fiber diet actually depletes the amount of fluid that the body will retain. Fiber actually holds the water, which gives the best cleansing affect, but our bodies needs to retain a certain amount of fluid to keep organs working properly, like the urinary tract. Drink, Drink, Drink, not milk products, keep that down to two glasses a day, but more water and juices. Preferably watered down juices so you are not getting all the calories. That brings us back to diet, we think ok we will bake with whole wheat flour, and add fruit to our cookies, breads, etc…but what about the extra calories from the sugars? Did you know that in many recipes you can cut back on the amount of sugar and use pudding mixes for the sweetness? And hey did you know that pudding mix in place of most of the sugar will actually make your cookies softer? Do you want to depend on baked goods for the only way to get fruits into the diet, no way, you are still looking at higher risk to forming a habit of a  high calorie diet, and a higher risk of defeating your purpose. So here we come back to moderation.

Where do we start, number one thing is never start a high fiber diet too fast. Begin slow, add high fiber foods slowly, until you are getting just the result you want, continue the needed supplemental vitamins and minerals. Monitor, monitor, monitor is the real key to a good nutritious high fiber diet. Don’t binge on high fiber, once you get the level that is right, stick with it, don’t go on and off like dieting, this is not healthy either. Like any good diet, once you find what works, without causing other problems, then make it a habit and stick with it.

So long as the things we are doing for Selena work, and keep it under control then we can rest assured none of the other more serious issues exist. Now, if what we are doing does not provide the results we want, then further testing and screening will be needed to rule out anything else that could be going on.

I guess you can see this is truly a team effort, and yes, we have our work out for us. I know we will be successful, and through the education, Selena will learn to maintain this on her own for many years to come. Education, this is the most important thing that we can now do for Selena!

Now with all of that said, we have a little girl, who is picky, not so much about taste but texture. So how are we going to get a high fiber diet going? Well we will have to pull out the blender, and add the vegetables, grains, and fruits to her normal foods. Again educating her on how the body works and why she needs all these foods that contain fiber, will hopefully help her to overcome her sensitivity to texture, and begin to eat them naturally. If that continues to be a problem, then she will need to learn to cook and add these foods in a way that will work for her. I am in no way saying that we have not done everything we can to make sure Selena is getting her fiber, but we need to work harder at it.

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  1. You're right her cleanse is totally different from Sam's, which was an all vegetable thing.

    Okay, that first part, ewwwww

    Second part very interesting.

  2. This is so interesting - thanks for sharing it with all of us. I'm sure it feels good to know you have a plan to help Selena. Good luck with everything... I'll continue to keep her in my prayers. And that's a great thing to know about pudding mixes!

  3. I am sorry that Selena doesn't like fruit naturally. Maybe it's worth experimenting with different fruits - the sweeter the better. Some fruits that work very well for us include watermelon, blueberries and grapefruit. I am sure that you will find the diet that works for Selena.