Consternation over Constipation

Constipation Outhouse

[originally published in KCN, September 2009]

For many of us, going “number 2” is just something we fit into our day.  Not much thought is given to it.  Sure, most of us have experienced an occasional, short-term bout of constipation, perhaps due to a shift in diet, not drinking enough water, or emotional stress.  But unfortunately, the $800 million spent each year in this country for laxatives tells us that for some, constipation is hardly “an occasional bout” — it’s a way of life.

Consider the story of an 8-year-old boy who, since the day he was born, would only experience a bowel movement once every 7 to 10 days — sometimes almost 2 weeks would go by.  And when he would finally “go,” it was a 1 to 2 hour experience in the bathroom that almost always ended up with mom or dad fetching the plunger.
A quick look on WebMD.com will educate you on the myriad of factors that can lead one to experience constipation:  inadequate water intake, inadequate fiber intake, disruption of  diet or routine, inadequate activity or exercise, stress, overuse of laxatives (oh the irony), medication side effects, depression, pregnancy, or even colon cancer, as examples.

For the little boy above, none of these were the case.

Constipation SittingWhile most of us will only experience what we might consider “constipation” [ie. “the slow movement of feces through the large intestine”] for a relatively short time period, doctors won’t officially diagnosis someone as having constipation until at least two of the following factors are present for at least 3 months:  straining during a bowel movement more than 25% of the time, hard stools more than 25% of the time, incomplete evacuation more than 25% of the time, and/or two or fewer bowel movements in a week.

While those in their Golden Years tend to be stereotyped as needing to eat their daily ration of bran washed down by a full glass of prune juice, many children are affected by the disorder as well.  In fact over 1 in 4 referrals to pediatric gastroenterologists are for chronic childhood constipation — like the child above whose parents also took him to this type of specialist.  They were told that he would continue to have constipation [confirming research that shows children generally don’t “grow out of it”] and would probably develop “megacolon,” putting him at a greater risk for colon cancer later in his life.  He was prescribed laxatives and advised to eat a high fiber diet and to increase his fluid intake.

What I haven’t shared with you yet is that at the very bottom of the WebMD list of the various factors that can cause constipation is this statement:  “In some cases, lack of good nerve…function in the bowel may also be the cause of constipation.” [emphasis mine]

Perhaps this is why the parents of the little boy sought the attention of a chiropractor after only achieving marginal success with the specialist’s directives.  In fact, their experience is not all that uncommon.  Research shows us that 30 – 50% of patients continue to have symptoms  years down the road despite medical intervention.

The chiropractor’s evaluation, for the most part, didn’t show much — except for a tender, swollen area located over a bone of the spine just below the lower back (S2).  The chiropractor determined that this vertebra was out of alignment.  Not coincidentally, the nerves that exit out the spine in this region service the last third of the colon to the anal canal.

Constipation TP rollWith an aim of restoring proper nerve function, the  wayward vertebra was then skillfully adjusted by the chiropractor.  After only one adjustment, an excited mother returned days later explaining that her son had, for the first time in his life, 3 bowel movements in a 4-day period.  She also explained that he was able to go to the bathroom with much greater ease and that the “end product” was much smaller and softer in texture.

Chiropractic care continued until the child’s bowel movements were normal and the offending area of his spine was no longer problematic (8 visits over one month).  A telephone call 13 years later found the now 21-year-old young man to have nearly “clock-like” daily bowel movements.

colic-jmptA true story which appears as a case study in the January 2007 edition of the Journal of Manipulative and Physiological Therapeutics. Unfortunately the research on constipation and chiropractic is rather scant.  Only a small handful of case studies exist — not enough to extrapolate overarching claims.

That said, I’m sure most chiropractors could share a success story or two.  I’ve had constipated babies blow out diapers following adjustments — much to the relief of their worried mothers; and I’ve had a middle aged gentleman confide in me, in a visit after the fact, that he had been constipated for quite some time.  He was wondering if the adjustment I had given him days before could have “freed him up.”  When I told him that it was very possible, he shared with me that he had to literally speed on his drive home that day after his adjustment to make it to the bathroom in time!

So, while chiropractic doesn’t have enough scientific evidence [yet] to boldly make any claims regarding constipation, “a pinched nerve” certainly should not be tossed out as a possibility — even if it is at the bottom of the WebMD list.  Because for those anecdotal patients that have been helped — whose lives have been changed — for them the term “regular” chiropractic adjustments, takes on a whole new meaning.

____________

Source used for this article:
Alcantara and Mayer.  The successful chiropractic care of pediatric patients with chronic constipation:  A case series and selective review of the literature.  Clinical Chiropractic.  11 (3):  138-147.  2008.
Alcantara and Mayer.  The successful resolution of chronic constipation in three pediatric patients following chiropractic spinal manipulative therapy.  European Journal of Integrative Medicine.  1(sup 1):  25-6.  2008.
Nurko.  Advances in the management of pediatric constipation.  Curr Gastroenterol Rep.  16:  213-8.  2000.
Quist and Duray.  Resolution of symptoms of chronic constipation in an 8-year-old male after chiropractic treatment.  Journal of Manipulative and Physiological Therapeutics.  30 (1):  65-68. 2007.
Redly.  The effects of chiropractic care on a patient with chronic constipation.  The Journal of the Canadian Chiropractic Association.  45 (3):  185-191.  2001.
Staiano, et al.  Long-term follow-up of children with chronic idiopathic constipation.  Digestive Diseases and Sciences.  39:  561-4.  1994.van Ginkel, et al.  Childhood constipation:  longitudinal follow-up beyond puberty.  Gastroenterology.  125:  357-63.  2003.
WebMD.com.  The Basics of Constipation.  Reviewed by The Cleveland Clinic of Gastroenterology.  http://www.webmd.com/digestive-disorders/digestive-diseases-constipation (as of 08/12/09).

UPDATE 05/13/2010: Just came across another case study to add to the mix.  This one is out of the Journal of Pediatric, Maternal & Family Health – Chiropractic. (Volume 2010 (2) 51-55), entitled “Resolution of Chronic Constipation and Neck Pain Following Chiropractic Care in a 6-Year-Old Female.”  In this report, the author found that his patient’s bowel movements improved from a frequency of once every 4-5 days to a frequency of once per day.  In addition, her neck pain resolved.  🙂

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