low tone causing bowel issues

I am the mother of 24 month old quintuplets,born at 31 weeks gestation. At 11 months of age we noticed that our son, Drayden began having a difficult time having consistent bowel movements, which at the time we attributed to the introduction of solid food. We had introduced solids at 8 months of age, but he had a severe reaction to sweet potatoes, which appeared to delay his desire to attempt solids for quite some time. At 13 months, Drayden was seen by a pediatric surgeon. We also consulted with Drayden's GI doctor who recommended myralax and suppositories. Drayden's bowel issues seemed to improve. However, in April, the problem again plagued us. Drayden had an abdominal x-ray which indicated a moderate-large amount of bowel in his colon. At 18 months of age, Drayden was diagnosed with hypotonia and therefore, we began exercises with his legs. Drayden began walking at 20 months of age. He has been seen by an orthopedic surgeon, who believes he is doing quite well despite the low tone and has been seen by 2 pediatric gastrointerologists, both of which have differing opinions on the proper treatment for Drayden regarding his bowel issues.
In October of 2008, Drayden had an ultrasound and Ct Scan of his abdomen and pelvis. Once again, he had significant bowel, the size of a softball and also a high resolution substance in his bowel, which is believed to be barium from his upper GI in 2007. Our doctor recommended a bowel disimpaction; however, two days before the proceedure, Drayden began having massive bowel movements.The proceedure was cancelled. He was placed on maintenance Myralax and Senekot. By Christmas, Drayden was completely backed up again. He receives physical therapy for his hyptonia and we have tried fibersure, glycerine suppositories and other over the counter products, and have considered potential chiropractic care to hopefully induce bowel movements.  We want to do what is best for our son. Do you have any suggestions?
Jenny

[Kevin Pho, MD]

There are a variety of reasons for constipation in children, and I agree with the workup thus far.

If there has already been evaluation with two pediatric GI doctors, it is unlikely that I will come up with something new over the internet.

Causes not to miss, and may already have been considered, include cystic fibrosis, lead poisoning, Hirschsprung's disease, and spinal dysraphism.  Each of these possible diagnoses should be considered by your son's GI physician.

Motility testing and anorectal manometry are two specialized tests that should be considered if the cause remains unclear.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd