Relief from Chronic Constipation, Painful Abdominal Contractions
Chronic constipation, abdominal swelling, and difficulty with swallowing may signal that your child has an intestinal motility disorder. The abnormal movement of food and drink through the GI tract can be difficult to diagnose. Duke’s pediatric GI team is highly skilled in identifying the cause of these conditions and helping children find relief. Our goal is to manage or eliminate symptoms and boost nutrition so your child can return to school and his or her favorite activities as soon as possible.
What Is a Motility Disorder?
Motility disorders occur in the upper and lower sections of the digestive tract. They include:
- Achalasia, which occurs when the esophagus cannot move correctly, leading to food backing up into the esophagus. This causes swallowing difficulties and vomiting.
- Gastroparesis, a delay of food moving from the stomach into the intestines. This can cause severe nausea, vomiting, abdominal pain, and weight loss.
- Pseudo-obstruction, which can be caused by slow movement of the small intestines, leading to abdominal distention and difficulties with eating.
- Chronic constipation. When a child's inability to have regular bowel movements is severe, blocks can form and can cause them to leak stool.
Our team of doctors is actively collecting data, especially about lower digestive-tract conditions such as chronic constipation, to share with other experts and improve available treatments.
How We Diagnose Motility Disorders
Our pediatric motility specialists use a variety of tests to diagnose the cause of your child’s pain and discomfort. Our motility team will talk with you and your child to take a very careful medical history. Your child’s doctor will determine which tests are needed, based on whether the problem is an upper or lower gastrointestinal issue. Lab tests, such as blood work, and X-rays are often prescribed. Other outpatient tests may include:
- Manometry: Studies how muscles contract and whether the squeezing action is strong or weak. This helps us determine how the gastrointestinal tract moves food and stool. Manometry can be used to test movement in the esophagus, small intestines, colon, and anus. Studies that look at the small intestine and colon may require an overnight hospital stay.
- Upper GI X-ray: Pictures of the esophagus and stomach are taken as your child swallows food or drink with a contrast substance added to make it stand out visually.
- Gastric Emptying Study: Monitors how food travels out of the stomach. A child swallows food or drink with an added contrast material. Doctors record and watch the material as it travels out of the stomach.
- Upper endoscopy: The doctor uses a thin, lighted tube with a camera to look inside the esophagus, stomach, and small intestine for damaged tissue. The tube is inserted through the mouth and down the throat. This can also be used to place other tubes needed for esophageal and small intestine manometry studies.
- Colonoscopy: The doctor uses thin, lighted tubes to check the linings of the intestines and colon. This can also be used to place other tubes needed for colonic manometry studies.
Our doctors use the test results to create the best treatment plan for your child.
A variety of treatments are available to reduce symptoms and correct digestive and bowel movement problems. Our doctors, nurses, physical therapists, and dietitians will work with your child and you to build a care plan that best meets your family’s needs. We are committed to helping your child feel better and in control of their body. The effectiveness of treatments depends on your child’s specific condition. We also work with your local pediatric gastroenterologist to continue your care after you are away from Duke.
Whenever possible, our doctors first use medicines to relax the muscles of the esophagus, encourage movement of the intestinal muscles, or promote regular bowel movements. The type of medicine your doctor recommends will depend on whether your child’s condition is an upper or lower digestive disorder.
Children living with a chronic condition, such as frequent stomach ache, vomiting, or constipation, may adopt behaviors that make them feel better. This can include not eating to avoid stomach pain or throwing up, or not using the bathroom to avoid the pain of a bowel movement. Pediatric nurses and physical therapists work with and talk with your child to understand their concerns, calm their fears, and teach them how to eat and use the bathroom so they can feel better.
Physical therapy exercises can address behavioral and functional issues, especially for chronic constipation. Children may be afraid of pain from a bowel movement and may not use the bathroom when they feel the urge to go. Our physical therapists work with your child to retrain the pelvic muscles. Therapy involves teaching children how to recognize when they need to have a bowel movement. Our physical therapists provide balance and stability training for toilet posture, breathing exercises, and specific therapy to help children safely strain and relax the abdominal and pelvic muscles when using the toilet.
Our dietitians work with you and your child to create an eating plan that will deliver the nutrition your child needs to maintain proper growth and development. Dietary changes can also help to reduce symptoms such as heartburn and irritable bowel issues. Our dietitians also may recommend vitamins and supplements as needed to keep your child healthy.
Even though we try to avoid it, surgery is sometimes needed if medicines and physical therapy are unable to manage your child’s symptoms. These surgeries can include stretching the esophagus, placing feeding tubes, removing sections of intestines, and placing tubes to allow daily enemas. We team with radiologists and pediatric surgeons to assist with these procedures.
Family and Support Services
When you bring your child to Duke Children’s, you may feel overwhelmed and have a lot of questions. Our team is here to help. Our doctors and nurses connect your child and you to many supportive services designed to make the experience more comfortable and positive.
Our child life specialists provide support, education, and guidance to help you and your child during testing, treatment, and hospitalization. Child life specialists explain procedures, offer encouragement, and use fun activities to take your child’s mind off treatment.
Our social workers can help you navigate the medical system and coordinate the variety of health services your child needs. We help you work with insurance providers, connect you with resources, and help you manage details related to your child’s care.
If your child is staying at Duke Children’s, you can relax in the Ronald McDonald House Family Room. You can grab a light meal, shower, do laundry, or use a computer with internet access.