What is Slow Transit Constipation in Kids?

With up to 29% of kids affected by constipation worldwide, now more than ever is the time to focus on building better gut health [1]. Regular constipation can be attributed to diet and hydration, but when it comes to slow transit constipation, the causes might not be so easy to pinpoint. What is slow transit constipation in kids and how can we differentiate when your kiddo needs additional medical support? Let's review the causes, signs, and distinctions between regular constipation and slow transit constipation in kids and how parents can use this information to help their kiddos build a better strategy for relief.

Understanding Slow Transit Constipation

Slow transit constipation occurs when there is a functional abnormality due to disordered nerves and muscles of the colon itself. Generally, a biopsy will show abnormalities of the neurotransmitters in the muscular layers of the bowel wall.

Specifically, those who have STC will have a deficiency of Substance P, which is a peptide involved in the activation of bowel contraction. In kids with STC, movement of stool within the colon is markedly delayed. The stool often remains stored in the right or middle portion of the colon and does not progress to the rectosigmoid colon, which causes a build up of stool. If the rectosigmoid colon does not function normally, then it’s harder for any stool present to expel naturally. [1]

Differentiating Slow Transit from Regular Constipation

While regular constipation often results from dietary factors, temporary lifestyle changes, or hydration issues, slow transit constipation involves a chronic slowdown of stool movement through the colon. This delayed transit leads to a range of distinct symptoms, setting it apart from the occasional constipation in kids.

Causes of Slow Transit Constipation

• Neuromuscular Dysfunction. Slow transit constipation can stem from neuromuscular issues where the nerves and muscles in the colon don’t function optimally, affecting the movement of stool.

• Structural Abnormalities. Structural abnormalities in the colon, such as anatomical defects or obstructions, can impede the smooth passage of stool, resulting in slow transit constipation.

• Genetic Disposition. Studies find that 1 in every 3000 infants and adults are diagnosed with slow transit constipation.

Signs of Slow Transit Constipation

Common signs specific to slow transit constipation include [4,5]:

• Infrequent Bowel Movements: Normal poop frequency is the passage of three or more bowel movements per week, but kids with slow transit constipation might not have a poop for 7-10 days during a constipation period.

• Lack of Urgency for Bowel Movements. Kids with STC may have long delays between passage of stools accompanied by a lack of urgency to have a bowel movement.

• Persistent Abdominal Discomfort: Complaints of abdominal pain, nausea, bloating, and lack of appetite.

Interventions for Regular Constipation vs Slow Transit Constipation

• Regular Constipation: Usually temporary and can be managed with dietary adjustments, hydration, and lifestyle changes. It can generally be resolved with these modifications [3].

• Slow Transit Constipation: Chronic and involves a prolonged slowing of stool movement through the colon. It may require more extensive interventions, including medical evaluation, medications, regular enemas, and sometimes surgery. Kids with STC may also require Interferential Electrical Stimulation Therapy, which helps increase bowel motility to improve their bowel emptying [2,4,5].

References:

[1] Hutson JM, McNamara J, Gibb S, Shin YM. Slow transit constipation in children. J Paediatr Child Health. 2001 Oct;37(5):426-30. doi: 10.1046/j.1440-1754.2001.00692.x. PMID: 11885703.

[2] Moore JS, Gibson PR, Burgell RE. Neuromodulation via Interferential Electrical Stimulation as a Novel Therapy in Gastrointestinal Motility Disorders. J Neurogastroenterol Motil. 2018 Jan 30;24(1):19-29. doi: 10.5056/jnm17071. PMID: 29291605; PMCID: PMC5753900.

[3] Anti M, Pignataro G, Armuzzi A, Valenti A, Iascone E, Marmo R, Lamazza A, Pretaroli AR, Pace V, Leo P, Castelli A, Gasbarrini G. Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Hepatogastroenterology. 1998 May-Jun;45(21):727-32. PMID: 9684123.

[4] Benninga, M A; Büller, HA; Akkermans, L M; Taminiau, J A. 16. SLOW TRANSIT CONSTIPATION IN CHILDREN ?. Journal of Pediatric Gastroenterology and Nutrition 17(4):p 461, November 1993.

[5] Frattini JC, Nogueras JJ. Slow transit constipation: a review of a colonic functional disorder. Clin Colon Rectal Surg. 2008 May;21(2):146-52. doi: 10.1055/s-2008-1075864. PMID: 20011411; PMCID: PMC2780201.