Chapter 48 - Chronic constipation and nausea in a child: Constipation and nausea in a child with hEDS leading to severe weight loss

Abstract

Functional intestinal symptoms, such as early satiety (fullness), postprandial pains (after eating), chronic nausea, and chronic constipation, are potentially presenting concerns in individuals with Ehlers-Danlos syndromes (EDSs) or hypermobility spectrum disorder (HSD). Upper gastrointestinal (GI) endoscopy with biopsies and fluoroscopy are helpful to arrive at the diagnosis of these symptoms. “Red flag” symptoms such as blood in the stool, severe pain with defecation, bilious vomiting, or abdominal distention should alert the pediatrician that the child may suffer a more severe form of constipation. In the case study described, impaired motility of the stomach and small intestine, poor coordination of the abdominal wall and pelvic floor musculature, and irritable bowel syndrome can all contribute to constipation. This chapter illustrates how nausea, vomiting, and weight loss may resolve once chronic constipation is addressed. It is important to recognize that difficulty with eating and digesting is not the same as having an “eating disorder;” eating disorders are associated with mental and physical illnesses that involve complex relationships with food, eating, exercise, and body image. Often EDS and HSD individuals are assumed to have—or are incorrectly diagnosed as having—an eating disorder, without having had a full assessment of their digestive concerns and their potential causes. These concerns are further discussed in other chapters in this section, primarily in the context of adult patients.