When lesions occur in the immature (peri-natal) brain, children develop chronic, non-progressive movement and posture disorders.  This is referred to as cerebral palsy (CP).  Mental retardation, seizures, oculomotor problems, speech problems, gastrointestinal reflux and swallowing disorders may accompany CP.  Constipation is also a significant and common problem among these neurologically impaired youngsters.  It is thought that constipation may be caused by impairment in how the gut is innervated in children with CP - thus delaying colonic transit time.  To evaluate this, researchers compared colonic transit time in children with spastic CP against their frequency of having a stool, their nutrient intake, functional level, and brain MRIs. 

Thirty-eight children with spastic CP in a rehabilitation hospital had their colonic transit time measured by ingesting 1 Stizmark capsule (these capsules contain many markers visible on x-ray) at 9AM each day for 3 days.  On the fourth day, a plain abdominal x-ray was taken and the position of these markers was assessed.  The frequency of constipation was as such:  10 children (of 38) had hard stool consistency and another 19 had difficult defecation.  Total and segmental colon transit times were significantly longer among these with constipation than those without.  Colon transit time was more delayed in children with CP who did not ambulate than those that did.  Non-ambulators were also more likely to have constipation.  Fluid intake, fiber intake and intake of other nutrients were not significantly related to colonic time or to constipation.  No child with normal MRI findings had constipation. 

(Park ES, et al.  Arch Phys Med Rehabil 2004; 85:453-456.)

Comment:  This shows that a disruption of how the gut is innervated in children with CP is a cause of their constipation.  Some of these children are also unable to move their muscles around the rectum and anus and this may also contribute to constipation.  Further investigations on dietary intake (e.g., fluid, fiber) are recommended before it is concluded that these therapies are not effective.   - H.T.