Chronic Diarrhoea

Question:

My eight-year-old son has had persistent diarrhoea for the past 16 months and soils himself day and night. He has been prescribed lactulose and Senokot solutions and his consultant recently upped the dosage considerably. After a few days, he began to pass extremely large soft motions (he never got to the lavatory in time). He is a fussy eater but what he does eat is relatively OK - cereal, fruit, bread -although he will only eat one vegetable. He also has plenty of fruit juice, milk and sometimes water. It has been suggested that his diarrhoea was triggered by the death of a grandparent. Do you think it was right to increase his medication?

Answer:

From what you say, it sounds as if the wrong medicines have been given to your son - unless there is something else going on that you are not aware of. Both Lactulose and Senokot are laxatives, meaning that they are drugs used to treat constipation and not Diarrhoea. I am not surprised that the poor child is soiling his clothes. Under such conditions, increasing the doses of these medicines is absolutely the wrong thing to do. My advice is that you should stop these medicines immediately.

Chronic diarrhoea will cause malabsorption of nutrients. The food matter does not stay long enough in the intestines to be properly digested. In a child, constant diarrhoea can be a major problem because it prevents the absorption of proteins, vitamins and minerals, which the child needs to grow. The action of the laxatives is likely to exacerbate this. For instance, calcium, magnesium and other minerals are absorbed in the colon, which is where the laxatives and purgatives are most active.

Laxatives contain mainly fibres (eg, senna, spinach, psyllium husks) or seeds (figs) which are indigestible and prevent the binding of stools. Purgatives, which are based on castor oil, chillis, magnesium salts, etc, are bowel irritants and cause excess fluid discharge from the gut walls, also causing the stools to be unnaturally soft and runny. Additionally, food poisoning, bacterial dysentery and intolerance to foods cause a similar reaction. The body tries to expel the pathogens (agents which cause disease) by discharging large quantities of fluid and mucus. This results in diarrhoea.

It is possible that stress due to the death of a loved relative could have triggered the initial condition, but you may never know. In chronic diarrhoea, my approach is to eliminate the physical causes, slow the bowel movement, help in stool binding and improve absorption of nutrients.

Here are my suggestions:

* Give your child a non-fibre diet to slow down the movement of the intestines and help stool formation. Restrict food to: potatoes, carrots, turnips, swede mashed with olive oil or a little butter, mushy peas, pasta with olive oil, minced red meat, chicken or turkey with garlic, ginger and salt, well cooked rice, oatmeal porridge, hard or soft boiled eggs, cottage cheese, live natural yoghurt kiwi fruit, peeled apples and plums, honey. Avoid green vegetables, roughage of any kind, spices and anything else that irritates the bowels.

* After two months, when the exclusion diet above has settled the bowels and the stools are better formed, gradually add other fruit such as bananas, pears and nectarines. and raw vegetables such as broccoli, courgettes, cabbage, asparagus and cauliflower. Always remove stalks as these contain the most roughage.

* Give him Multivitamins: eight drops daily for two months.

* Make sure he drinks plenty of still water - at least six glasses daily.

* Introduce exercise such as swimming, walking and ball games. The more exercise, the better the absorption of food because the body needs the nutrients.

* Pomegranate juice is good for binding stools. If you can find the juice, give him a quarter of a cupful twice daily for 15 days. Or buy a fresh pomegranate and boil a quarter of the peel in four cups of water for 15 minutes. Let it cool for an hour. One cup should be drunk twice daily for ten days.

* Massage his abdomen gently, clockwise, with a little sweet almond or sesame oil for two minutes at bedtime, for two weeks.

* If the diarrhoea persists for more than a month despite taking the above measures, you must take your child to see a different physician to investigate the causes. Talk to your GP about finding someone who is sympathetic to complementary medicine.