2020 Volume 56 Issue 6 Pages 955-960
A 5-year old boy with autism spectrum disease (ASD) was referred to us for the treatment of fecal incontinence due to fecal impaction. Bowel disimpaction followed by administration of oral laxatives and enemas temporarily relieved the symptoms, which recurred six months after the suspension of the outpatient visits. He became completely unable to defecate because of defecation-related anxieties, and he required hospitalization for the management of the obstructive symptoms. Periodical rectal irrigation of the clay-like feces was started on the outpatient basis twice a week at the age of seven, but he still refused to defecate. Polyethylene glycol (PEG) became available in Japan for treatment of constipation and was started at the age of ten, which gradually improved the fecal condition to muddy feces. Two months after the introduction of PEG, he was finally able to defecate by himself while sitting on the toilet and has not required rectal irrigation since then. His bowel movement has been well managed with PEG monotherapy during the follow-up period of half a year. The causal relationship between ASD and constipation remains unclear, but sensory hypersensitivity and compulsive behaviors due to ASD in this patient may have worsened his defecation-related anxieties. PEG administration seemed to have made the patient recognize the softened stool, which led to a successful behavioral change from refusing to defecate to self-defecation. Furthermore, from the standpoint of fewer side effects, such as abdominal pain or distention with other laxatives, the maintenance therapy with PEG is effective for intractable constipation in children with ASD.
