Supporting kids with chronic bowel and bladder conditions

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NiDKiDS is a program that provides information and support to families, medical and allied health practitioners from all over the world that support children and young people diagnosed with Neuronal Intestinal Dysplasia (NID) more commonly known as Slow Transit Constipation (STC). Below is a series of fact sheets that provides comprehensive information about assessment, diagnosis and treatment options for patients and their families. Whilst this information has been provided by PCAA under the guidance of the Paediatric Continence Advisory Council, the information is not intended to replace your physicians advice.

What is NID/STC

How is it diagnosed

Transit Study

Laparoscopic Biopsy

The importance of good management

Washout Solutions

Interferential Therapy Treatment

Appendicostomy (CHAIT)

The importance of Diet

Jack's Story

Our son Jack was born on July 31, 1996 in Melbourne, Australia. He was two weeks early and he weighed 8lb. I had a two-hour labour, which I thought was great. Jack’s sister Kate, who was three at the time, was a real help. Jack’s first poo was a lot later but Steve and I did not take much notice at the time. Jack was a very unhappy baby. All he did was cry and vomit! His belly was always very big and he did not poo much. Kate was very much the same, so I gave Jack liquid Coloxyl, which is what I did for her.

When Jack was four weeks old, Steve and I took him to our doctor who, in turn, sent us to a paediatrician; he thought that it was reflux and put Jack on Prepulsid, Zantac and Mylanta. But things did not get better. When he was nine months old, we stopped the Prepulsid, Zantac and Mylanta and that’s when four to five days without a poo stretched to ten days. As instructed by the doctor, we gave Jack enemas three to four times a week to keep his bowel clean. That was okay for a while but he was still a baby and he didn’t really know what was going on.

He was 10 months when he first went into the Royal Children’s Hospital in Melbourne. By the time he was 12 months old we were asked to make alternative childcare arrangements, as his Day Care couldn’t cope with his crying which was upsetting the other children! So we tried Family Day Care for the two days a week I was at work. Jack was still a very unhappy child and by Christmas 1998 he would not eat much and it would be as long as 14 days between motions. By now the laxatives and enemas were becoming less effective. It became a battle to change Jack’s nappy as he thought that we were going to give him ‘medicine’ (the enema). He was always trying so hard to do a poo. He would sit on the floor with his knees bent up to his chest and his left hand over his mouth because he would vomit. When Jack did ‘go’, it would be in volume and he would also vomit! Thank God for floorboards.

All the doctors we went to see would tell us it was just normal constipation, that it was becoming a habit and that we should continue with the laxatives and enemas. I remember that week I give Jack 60mls of Actilax and six squares of chocolate Laxettes and still he did not go! We ended up again at the Royal Children’s. This went on and on until a friend told me about a clinic at the Royal Children’s where she took her boys to deal with a problem they were having with soiling. It was March 1999 and I decided to make an appointment.

We told the doctor what Jack had been going through. He had his first x-ray that showed he was very full. Jack’s fluid intake was very good and he was on a very high fibre diet (later when I took Jack to a dietician, we were told that a low fibre diet would be better, which we found to be true). Jack still went 2 to 3 weeks with out a motion but his belly did not get quite as big so he was not in so much pain. After about six weeks, Dr Murphy told us that Jack had more than just constipation and referred us to Professor John Hutson at the Royal Children’s Hospital.

Jack had a nuclear transit x-ray, which showed that his bowel was very slow and then Prof. Hutson took a biopsy of Jack’s large bowel in six spots. Prof. Hutson told us that Jack had a rare bowel disease called neuronal intestinal dysplasia (NID). Most people have something called substance P in their body that tells them they need to have a bowel movement - Jack does not have substance P. He told us that there is no cure and explained Jack’s options, which was to try weekly bowel washouts, and if this did not work, to have one of two procedures - appendix stoma (no bag, Malone procedure) or colostomy (bag).

Finally we knew what Jack’s problem was, and we had a name for it. It was very sad but at least we understood what was happening and we could deal with it better. We did weekly large bowel washouts for about a year. I did it for a while but I got so upset one day when I started to realise Jack began to hate me going anywhere near him. My husband Steve took over, with the help of a very dear friend who is a nurse, but it did not get any better.

He now went four weeks without a movement and the bowel washouts were not working, I kept a diary detailing things such as laxatives, enema solution, diet, fluid intake, movements and amount. I also diarised his behaviour patterns - his behaviour was very bad and deteriorated during ‘build up’ but, when he was not so ‘full’, he was ‘our boy’ again. During all this time, our daughter Kate was dealing with the same tension and pressure that we all felt.

In January 2000, we went to see Prof. Hutson. We decided the best course of action was for Jack to have a colostomy so he could stop all the laxatives and bowel washouts and just try to be a normal little boy. Jack had his colostomy in March 2000. By the time he had his operation it had been 11 weeks without a motion. At first it was all so new and it was very hard for Jack to understand what was going on. When we got home from hospital things were very hard. Jack would cry when I had to change him and we also had to clear out his large bowel. We did this with GoLYTELY washouts through a catheter that had been placed above his colostomy. It took five litres of GoLYTELY to clear the bowel! Later, Prof. Hutson took the distal mucosa catheter out - which he did in his rooms and it was very quick. Over time, Jack became more and more comfortable with the bag and the changing procedure. He started to take an interest in what was happening and to want to learn how to do the change himself. For more than a year now Jack has been a happy, ‘normal’ boy and we have been a happier family for it.

Maryanne, Jack's Mum

PCAA is a member of the following organizations


Members of  Continence Foundation of Australia

Chronic Illness Alliance

 

 

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Copyright © 2007 Paediatric Continence Association of Australia Inc. All rights reserved.
Last modified: 11/17/08.