Kidney Reflux Information and Articles

We were well into Lizzie’s journey before discovered there was a connection between constipation, voiding dysfunction and vesicoureteral reflux. It was first mentioned by the urologist that we saw for a second opinion. I was surprised when one of the first questions he asked was if she had any problems with constipation? Too be honest, it left me scratching my head for a minute. Does she have problems with constipation?  I didn’t really know She was constipated at times, but no more than any other kid I guess, why did it matter?

After discussing some of the issues related to constipation and reflux, I began to realize that the answer to that question was pretty important. Even mild, sporadic constipation could have negative effects on Lizzie’s urinary system. I went home and started doing some research. I needed to understand why it caused problems and what I should be doing to prevent it. I was surprised at the amount of information out there. How had I never seen any of this, and why had no one mentioned it before? What I discovered is that parents of children with kidney reflux need to be especially diligent when it comes to constipation. Not only is constipation uncomfortable for the child, but it can lead to recurrent urinary tract infection, and may actually delay the resolution of reflux among other complications.

Constipation is defined as a very hard stool, pain that is associated with passing stool, or failure for a child to pass three stools in a seven day period. So what is it about constipation that makes it so dangerous for children with reflux? When a child is constipated, the stool that is impacted in the rectum compresses the bladder, which can reduce the capacity of the bladder and give the child an earlier sensation to void. This can in turn prevent relaxation during voiding which can cause urine to remain in the bladder after voiding, which basically means that the bladder does not empty completely. The danger is that the longer urine sits in the bladder, the greater chance bacteria has to colonize in the urine, which can lead to urinary tract infection.

Another theory is that once a child has had a painful experience passing stool, they are more likely to withhold stool in order to avoid another painful experience. This starts a vicious cycle of further constipation, and other complications. When a child withholds stool, they will usually withhold urine as well. Again, this leads to pressure on the bladder, and urine being left in the bladder. Voiding dysfunction is cyclic and can be hard to treat once habits have set in.

I began reading about how voiding dysfunction and constipation are closely linked, and when seen together, they are referred to as Dysfunctional Elimination Syndrome (DES). This is one of the articles that I found very interesting. It discusses the impact of constipation, dysfunctional elimination syndrome (DES) and Vesicoureteral Reflux specifically. It talks about a study that showed for patients that did NOT have DES, only 18% experienced breakthrough UTI’s and eventually needed surgery. Kids with breakthrough UTI also had a much higher rate of DES, 77%. Many of the children that were able to control their DES, also helped in resolution of reflux. Even though this was a small study, I found these statistics pretty significant.  I immediately saw the importance of treating constipation and voiding dysfunction.  The article went on to talk about how the resolution rates of reflux are delayed in children with DES. Resolution rates are lower and slower, and may take an average of 1.6 years longer for reflux to resolve. That’s a long time when you think of the chances of recurrent infection, as well as all of the testing and antibiotics required to manage VUR.

Now that we understood the importance of eliminating constipation, our next step was trying to figure out what steps were needed to manage it and prevent it. We quickly realized that this was sometimes much easier said than done.

The first thing we did is increase Lizzie’s fiber intake by adding more fruits, whole grains and vegetables to her diet. We also decreased some of the more binding foods, like bananas and cheese. We increased her fluid intake which is a big key to treating and preventing constipation. For a lot of children, changing diet may be enough to keep the bowels moving well. For others, a supplement may need to be given in order to keep the stool soft. Our doctor recommended Miralax, which is given daily.

For severe constipation, or impaction, a child may need multiple high doses of Miralax or stronger methods in order to clean out any impaction before starting a daily routine. You should discuss dosages with your doctor, and may also want to discuss doing an x-ray to diagnose impaction.

Lizzie still sometimes struggles with occassional constipation, but by changing her diet, increasing her fluid intake, and using Miralax daily, we have eliminated a lot of her constipation issues. I believe that in our daughter’s case, this has also helped relieve some of her bladder spasms which can also be caused by constipation. When I first started reading about all of this, I didn’t even realize that my daughter was having any constipation issues. Now I feel like we are taking one more step toward helping her body heal, and giving her a greater chance of resolution.