Managing Toddler's Mega Colon
Hello Doctors, I have a 1.5-year-old son who is approximately 90 cm tall and weighs 12 kg. He's been struggling with chronic constipation for over a year, leading to a hospitalization when he was 9 months old for a thorough cleanse. Recently, he underwent exploratory surgery to investigate his ongoing constipation, during which it was revealed that he has an enlarged descending colon, measuring more than 5 cm in diameter. The medical team opted against performing a biopsy for Hirschsprung’s disease, citing the absence of the typical narrowing in the rectum and anus. Additionally, as he has moved beyond infancy, they noted that obtaining sufficient tissue for testing would increase the risks of infection, pain, and bleeding. We are currently waiting for a referral to see a gastroenterologist. However, I wanted to reach out for any advice on how to manage his condition in the meantime. I've learned that if his colon becomes excessively stretched or perforated, it could escalate into an emergency situation. At present, he is taking senna daily to help with bowel movements. Occasionally, he uses Movicol as a softener when senna doesn’t seem effective. However, I've noticed that Movicol alone does not lead to frequent bowel movements. For reference, I believe Movicol is similar to Miralax in the USA. Although he doesn't have a daily movement, we're cautious about raising the senna dosage due to the cramps it causes him. I appreciate any guidance you can provide!
Answers (1)
6/15/2025, 9:01:20 AM
OpenHealth AI
It sounds like you're navigating a very challenging situation with your toddler's chronic constipation and megacolon. Managing his condition is crucial to preventing complications, such as bowel obstruction or perforation, which can be concerning for both parents and caregivers. Here are some tailored strategies that may help in the meantime while waiting for the gastroenterologist appointment.
Main Points
- Hydration and Diet: Increasing fluid intake and dietary fiber can support regular bowel movements.
- Medication Management: Careful adjustments to current medications may be necessary.
- Monitoring Symptoms: Keep a close eye on his bowel habits and any potential signs of distress.
Explanation
Chronic constipation in young children can often stem from various causes, and it sounds like you’re already aware of the potential complications with megacolon. Since his colon is enlarged, managing the pressure and promoting regular movements is essential. The medications you're using (senna and Movicol) are helpful in softening stool and stimulating bowel movements, but it's also important to monitor how your child responds to them.
Specific Next Steps
-
Hydration: Ensure your son is drinking adequate amounts of fluids, particularly water. Adequate hydration helps in softening the stool.
-
Dietary Fiber: Incorporate fiber-rich foods into his diet, such as:
- Fruits: Apples, pears, berries, and prunes (these can have a natural laxative effect).
- Vegetables: Peas, broccoli, and carrots.
- Whole grains: Oatmeal or whole-grain breads and cereals.
-
Medication Adjustments:
- Discuss with your healthcare provider on the proper use and dosage of both senna and Movicol.
- If you’ve noticed that senna is causing cramping, it may be best to discuss possibly reducing the dose or switching to another medication that acts more gently, if recommended by the gastroenterologist.
-
Regular Schedule: Try to establish a regular time for bathroom use each day. Encourage him to sit on the toilet after meals as this can help promote bowel movements due to the gastrocolic reflex, where the bowel responds to food in the stomach.
-
Monitoring: Keep a log of:
- Bowel movement frequency and consistency.
- Any signs of discomfort, pain, or changes in behavior.
- The effectiveness of dietary and medication changes.
-
Signs to Seek Immediate Care: If you notice signs of severe discomfort, significant abdominal swelling, fever, or vomiting, seek medical care promptly.
Final Note
It's excellent that you're seeking information and being proactive about your child's health. Once you meet with the gastroenterologist, they will provide more tailored treatment options based on your son’s specific needs and condition. Continue the current regimen while monitoring his responses closely. Your attentiveness and care will greatly benefit his management and help ensure everything is aligned for his health.
Related Questions
Assessing My Health Concerns: How Anxious Should I Be?
I’m a 32-year-old woman, weighing 124 pounds and standing at 5 feet 6 inches tall. For over a year, I have been experiencing bright red rectal bleeding. Initially, I attributed this issue to hemorrhoids that developed during my pregnancy two years ago. The bleeding occurs with most of my bowel movements, sometimes happens without one, and on a few occasions, has been enough to stain the toilet bowl significantly. The color of the blood is typically darker than what I observe during a hemorrhoid flare-up. There is a notable family history of bowel cancer on both sides; one family member was diagnosed at age 45, and another at 60. In the past six months, I have encountered several episodes of severe abdominal pain—3 to 4 instances—intense enough to consider a trip to the emergency room. However, the pain usually subsides within about an hour. It’s unusual for me to experience such acute pain, given my high tolerance for discomfort; for example, I once played rugby shortly after dislocating and fracturing my finger. Recently, I mustered the courage to consult with my doctor, who recommended a FIT test, which returned a positive result (30.1). Additionally, I underwent a complete blood test, and aside from having low ferritin levels (7 µg/L), all other results were normal. I have since been referred for a colonoscopy on a two-week waiting list to rule out any possible bowel cancer. Given these circumstances, how concerned should I be? Thank you for your input.
Understanding Possible Seizure Triggers and Recurrence Risks
Health Background: I am a 21-year-old female, standing at 169 cm and weighing 65 kg. Over the past three years, I have been using oral contraceptives. As of this morning, I started taking 25 mcg of levothyroxine along with a weekly vitamin D supplement of 0.266 mg. Recently, I was diagnosed with hypothyroidism and found to have a vitamin D deficiency that I suspect has existed for the last three years. I do not consume alcohol or smoke, and I can confirm I am not pregnant. Two years ago, I experienced a mild concussion. I currently reside in Spain. A couple of months back, in mid-December, I blacked out twice. The second occurrence took place while I was at the doctor’s office after seeking urgent medical care for the initial incident. Following the second episode, I underwent a CT scan and an EKG, both of which returned normal results. Further tests, as directed by my physician, revealed a critical vitamin D deficiency and hypothyroidism; however, he expressed doubt that either of these conditions led to my loss of consciousness. I was then referred to a neurologist, and I am presently awaiting an appointment. Although the waiting period is lengthy, my doctor indicated that I should receive priority for scheduling, although the exact timeframe remains uncertain. The referral document summarized my events, labeling the second episode (which the physician witnessed) as a potential seizure devoid of tonic-clonic movements—a revelation that took me by surprise. After regaining consciousness, I felt extremely disoriented and terrified, struggling to process what was happening. I have no prior history of seizures, epilepsy, or any related conditions, and there is no known family history of these issues. If this indeed was a seizure, what might have triggered it? Additionally, what is the likelihood of experiencing another one? Since that time, I have not had any further incidents, but I have experienced moments where I felt a sense of impending doom, which I managed to overcome. I intend to wait for the neurologist's evaluation, but the uncertainty surrounding a possible neurological condition is quite distressing. Thank you for any insight you can provide!
Persistent Pain in Right Shoulder and Arm After Lifting
Hello, everyone! I’m a 23-year-old male and have been engaged in weightlifting for several years now. Recently, I’ve been struggling with ongoing discomfort in my right shoulder and arm, which I haven’t been able to accurately identify. The pain manifests during particular movements, especially with lateral raises or when my arm is raised to shoulder level while rotating my wrist. Certain pressing and pulling activities can also provoke this discomfort. Rather than feeling sharp, it’s a deep, nagging sensation that sometimes seems localized in the front area of the shoulder or at the biceps tendon, and at other times it feels more like it’s situated between the shoulder and upper arm. Fortunately, there’s no numbness or tingling involved. This issue began while I was working out. I decided to take a break for around two months, but when I returned, the pain persisted. After consulting a physician, I was diagnosed with bicipital tendinitis. Since then, I’ve reduced my upper-body workouts, completely steering clear of shoulder exercises and heavy lifting, and have begun a gentle rehabilitation regimen focusing on external rotations, pendulum movements, and scapular exercises. Despite adhering to this routine for about a week, I haven’t experienced any noticeable improvement. Is it typical for this type of tendon injury to require an extended period for recovery? At what point should I consider diagnostic imaging, such as an ultrasound or MRI? Additionally, are there frequent rehabilitation errors that might impede the healing process? I appreciate your insights in advance!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.
Understanding Atrial Fibrillation and Thyroid Issues: Variability in Cardioversion Decisions
Hello everyone, I’m reaching out for guidance regarding my mother’s current health situation, and I’d greatly appreciate any shared experiences or thoughts. **My mother's background:** - **Age**: 55 years - **Weight**: Recently dropped to 116 kg from 118 kg in just two days, likely due to diuretics. - **Health history**: Previously an underactive thyroid, undiagnosed and untreated, now presenting as overactive. - **Medications**: Currently taking thyroid medication and a beta-blocker (Rapiblock). **Current health status:** My mother has been hospitalized since Tuesday, experiencing **atrial fibrillation with heart rates exceeding 200** beats per minute due to her thyroid's hyperactivity. - The plan for cardioversion was initially settled on Tuesday. However, the following day, the medical team advised postponing it until her thyroid levels could be stabilized, believing that her heart rate would return to normal once her thyroid condition was managed. - Her **obesity** precludes her from undergoing a transthoracic echocardiogram, and due to her thyroid concerns, she cannot handle contrast dye (this has been a consistent issue for over four years). Therefore, the only feasible option was a **transesophageal echocardiogram (TEE)**, which has yet to be performed. - She has been prescribed various medications including beta-blockers and thyroid treatments in the past. - On Friday, a doctor proposed proceeding with cardioversion; however, the attending senior physician objected. - Today (Saturday), another clinician has expressed a desire to move forward with cardioversion, having initiated a new medication, as the senior physician is unavailable. - **Communication has been unclear**, as we were notified of developments by a nurse rather than the physician in charge, causing confusion and anxiety. - Currently, only a **chest X-ray** is scheduled, and the TEE remains unaddressed. **My inquiries are as follows:** 1. Is it common for medical professionals to have varying opinions and frequently revise medication or treatment plans like cardioversion? 2. Is it safe to conduct cardioversion in the absence of a TEE? I presumed that this was a standard procedure to exclude the presence of blood clots. 3. Is it usual practice to have only a chest X-ray prior to moving ahead with cardioversion? 4. How typical is it for patients or their families to not be directly informed about treatment changes and learn about them through nursing staff instead? I recognize that this cannot substitute for professional medical advice. I’m simply trying to discern whether these circumstances are typical or if we should express our concerns more assertively with the healthcare facility. Thank you for your insights!