Evaluating Chronic Constipation and Abnormal Colonic Motility in Children With Autism Spectrum Disorder

Evaluating Chronic Constipation and Abnormal Colonic Motility in Children With Autism Spectrum Disorder 1024 680 JoAnna Pendergrass, DVM
Close up color photo of little boy holding hands on his belly

In children with chronic constipation, rates of abnormal colonic motility are similar between children with and without autism spectrum disorder (ASD). For children with ASD, symptom duration and soiling due to fecal retention are risk factors for abnormal colonic motility.


Treating constipation in children with autism spectrum disorder (ASD) is challenging because of feeding difficulties, sensory challenges and other ASD-related behavioral issues.

Poorly treated constipation has several consequences.

“Uncontrolled constipation in children with ASD can lead to disrupted sleep, poor eating habits and poor performance in school,” says Kent Williams, MD, a pediatric gastroenterologist at Nationwide Children’s Hospital. “It can also eventually lead to physiologic changes in the colon.”

Compared to children without ASD, children with ASD experience constipation more frequently and have more emergency department visits and hospital admissions due to their constipation. However, a definitive cause of constipation in children with ASD remains unidentified.

In a recent retrospective study of chronic constipation in children with ASD, Dr. Williams and his research team reported that abnormal colonic motility is no more frequent in children with ASD than those without ASD. They also identified clinical risk factors of abnormal colonic motility in children with ASD.

Results were published in the Journal of Pediatric Gastroenterology and Nutrition.

The study included 35 matched cohorts of children with ASD and without ASD (control group) who underwent colonic manometry at Nationwide Children’s Hospital and Cincinnati Children’s Hospital Medical Center between 2012 and 2018.

Patient data were collected on demographics and chronic constipation history, including symptom duration, presence of soiling and results of a water-soluble contrast enema (WSCE), if performed.

Abnormal colonic manometry findings were defined as the absence of high amplitude propagated contractions at defined time points (baseline, after a meal, or after bisacodyl stimulation) in the entire colon or a segment.

Similar rates of abnormal colonic manometry were observed between the groups: 24% in the ASD group and 20% in the control group. The rates of an abnormal WSCE were also similar between groups: 68% in the ASD group and 71% in the control group.

“These results indicate that the causes of constipation in children with ASD are primarily functional and are not due to an underlying neurologic or motility disorder,” Dr. Williams explains.

To identify clinical risk factors of abnormal colonic motility in children with ASD, the researchers then developed a prediction model.

This model has several benefits.

“The prediction model helps identify children with ASD who might be at risk for physiological changes due to chronic constipation. It also helps identify children who would benefit the most from colonic manometry and further evaluation,” says Dr. Williams.

Symptom duration and soiling were identified as clinical risk factors for abnormal colonic motility in children with ASD. Specifically, the risk of abnormal colonic motility increased by 11% for every 1-year increase in constipation symptoms. Compared to matched controls with soiling, children with ASD with soiling were 31 times more likely to have abnormal colonic motility.

Surgical treatment options, such as gastrostomy tube placement and appendicostomy, are available for children with abnormal colonic motility based on colonic manometry. A change in medical therapy could also help treat colonic motility issues in these children.

Dr. Williams’ continued research plans include evaluating treatment outcomes in children with ASD who received an appendicostomy and identifying children with ASD who would most benefit from surgical interventions to treat their chronic constipation.

Coe A, Ciricillo J, Mansi S, El-Chammas K, Santucci N, Bali N, Lu PL, Damrongmanee A, Fei L, Liu C, Kaul A, Williams KC. Evaluation of Chronic Constipation in Children with Autism Spectrum Disorder. Journal of Pediatric Gastroenterology and Nutrition. 2023 Feb 1;76(2):154-159.

About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.