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H's Brother

my little penguin

Moderator
Staff member
How is his fecal cal ?
Still on daily miralax ?
A lot of kids who have constipation as part of crohns need daily miralax
Ssri are not recommended for kids (under age 25 ) unless there is mental illness since they increase suicidal thoughts (all have black box warning so to speak )

what other activities are in this time frame ?
Busy with activities sometimes means more car time less home time and faster meals
So less time to “go” right or eat right

more stress from school (first month is review )

lots of factors
And sometimes we have found with Ds
It’s just crohns -others more miralax daily
Whole Foods
And exercise/rest/water ratio
 

crohnsinct

Well-known member
It is a great book but as you know; as much as they kept thinking that O had some sort of IBS overlay she didn't and we kept coming back to IBD. Even this last two weeks on the Xifaxan to treat bacterial overgrowth (which isn't necessarily IBS per se but is thought to be the contributing factor of a lot of IBS issues) hasn't helped her. I might rather pull a fecal cal test to see where he is and once IBD inflammation is ruled out then go down the IBS route. Although, changing diet to treat IBS can't hurt him other than delaying discovery of IBD inflammation.

Years ago there was a lot written on the parents forum about how kids seemed to flare up a bit with the start of school and the fall. The thought being stress is a contributing factor. Emotional stress but also stress on the body. As O's GI explained when we were sending her back to school, stress on the body (lack of sleep, running to class, swim practice etc) means that the body switches from healing to maintaining and just keeping up and that jeopardizes a flare. So could be stress that is causing IBS or stress that is causing IBD inflammation...clear as mud.

One good trend I am seeing these days is a huge amount of research on IBS and the fact that the gastro circles are taking it very seriously. There are even gastro psychologists who are studying and treating the brain/gut issues (IBS). I will see if I can pull some of the research and posts of late.
 

Tesscorm

Moderator
Staff member
I recall discussing Fall flares and something else that came up were allergies?? When S was flaring for the first time and we were still trying to figure out what was going on, he was given Cipro to treat possible stomach bug. He had two doses and had an allergic reaction (hives). He and was given an anti-histamine and told to take it for a couple of days. His crohns symptoms (fever, nausea, etc.) went away for 3+ weeks. That was the longest stretch of being symptom free that he'd had for months.

I suppose it may have been the two doses of cipro??

But, in the past, I do recall reading about some connection to either allergies and/or anti-histamines. Does C have allergies? While it wasn't allergies that triggered S's initial crohns symptoms, it did seem that the treatment for his allergic reaction (anti-histamines) alleviated his Crohn symptoms at the same time??
 
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Another thought Tesscorm, is that his immune reaction switched gears to attack the med, and so it calmed the Crohn's for a time.

Sort of a "bait and switch".
 
C doesn't have allergies that we know of.

I have avoided calling the GI as I like to give it a few days to rule out a gastro bug, but I guess today is the day.

I feel better armed with experience and advice this time thanks to the committee. I am going to ask about different types of meds, possibly looking for something that stimulates gut motility better than Miralax. The osmotics don't work too well for him in our experience, at least when he gets like this. He will respond a bit to Senna, but it does cause pain, and I'm not sure if he should take that regularly.

I will ask about IBS-C.

I will ask about fcal .

But major focus motility....I think.
 

my little penguin

Moderator
Staff member
So he isn’t on daily miralax.?
Ibs c is only when you ruled out crohns
He has crohns with constipation which means
He will have constipation blips similar to other kids diarrhea blips with crohns
It’s not a flare per say but is watched as it can lead to a flare
It’s not ibs-C
 

my little penguin

Moderator
Staff member
I did want to add

sometimes the muscles do not work properly to produce a bm (if he has this issue consistently ) then they can do more invasive testing to determine treatment

in Ds case his constipation gets worse
Spasms the gut causing pain /constipation even with miralax
Tends to be mild rectal inflammation/prolapse of sorts
Fecal cal tends to be normal since just the rectum is affected
Uceris foam has fixed the issue in the past but it takes a few months
 

Maya142

Moderator
Staff member
My kiddo has horrible motility pretty much everywhere and add that to pain medications and there is no way she'd go without a laxative. Miralax works most of the time, but sometimes when things are really bad, we go to Milk of Magnesia. It is NOT a stimulant, it's also osmotic. But in our experience, it works much more quickly and better than Miralax. M has no cramping with it, like she has with Senna or Dulcolax. Her pediatric GI recommended it.

Generally they do not recommend long-term stimulant laxatives, because you essentially become dependent on them. Which is why Miralax and Milk of Magnesia are typically recommended first.

I would definitely ask if it could be his Crohn's since small bowel Crohn's can cause constipation. Fecal Cal should tell you about that.

If inflammation is ruled out, then you look at motility issues or IBS-C.

If he is dealing with moderate to severe chronic pain, another important specialist to see is a pain psychologist. They are now usually psychologists who work with kiddos with chronic illnesses/chronic pain. Our children's hospitals has 4-5 psychologists that work specifically with GI patients.

In terms of SSRIs, it is true there is an elevated suicide risk if the patient is under like 25. But it's very rare. And untreated depression, anxiety or chronic pain can cause serious issues, so you have to weigh the risks and benefits. There are also specific meds for IBS-C that help you have more regular BMs, but I have no idea if they are used on kids. We haven't ever tried them but that's because generally either Milk of Magnesia or Miralax works for my girl.

My daughter recently developed post-infectious IBS, due to months of C.Diff. We tried the drug crohnsinct mentioned - Xifaxan. M lasted 4 days on it the first time - it caused such bad nausea. She re-tried it several weeks later because she was still having diarrhea and cramping and belly pain, and that time lasted a week. It didn't seem to help her unfortunately.
 
After labs and rectal check at hospital we did an enema, followed by weekly pico-salax starting tomorrow, and daily miralax.

I'll find the Canadian version of milk of magnesia and keep it around for good measure.

The ER doc talked to our GI. Those were the recommendations.
 
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Reactions: pdx

Maya142

Moderator
Staff member
Oh poor kiddo - enemas can't be easy at that age. I hope the change in laxatives does the trick. One thing to keep in mind with Milk of Magnesia is that if you take too much, it can cause diarrhea. So start with a small amount.
 
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