Slow Transit Constipation in Grand Rapids, MI

Understanding symptoms, diagnosis, and treatment options for children and families in West Michigan

Slow transit constipation (STC), formerly known as neuronal intestinal dysplasia (NID), is a chronic condition where the large intestine moves stool much more slowly than normal. This reduced motility is caused by abnormalities in the enteric nervous system (ENS) – the network of nerves that controls the muscles of the bowel.

For families in Grand Rapids and across West Michigan, slow transit constipation can significantly affect a child’s comfort, health, and quality of life. Early recognition and specialized care at local pediatric centers, such as Helen DeVos Children’s Hospital (part of Corewell Health / Spectrum Health), can make an important difference.

What Is Slow Transit Constipation?

In a healthy bowel, the large intestine moves waste along by rhythmic muscular contractions called peristalsis. These contractions are controlled by the enteric nervous system, which uses chemical messengers (neurotransmitters) to signal the bowel muscles to contract and relax.

In slow transit constipation:

  • The nerves in the bowel may be abnormal in number, position, or appearance
  • Neurotransmitters in the bowel wall may be abnormal or reduced (for example, reduced levels of a peptide called substance P, which helps stimulate peristalsis)
  • As a result, the large intestine moves stool very slowly, or not effectively enough

This unusually slow passage of stool leads to chronic problems such as:

  • Persistent constipation
  • Infrequent bowel movements
  • Uncontrollable soiling (fecal incontinence)

STC is considered a neuromuscular problem of the bowel rather than a simple diet or behavior issue.

Slow Transit Constipation in Newborns and Infants

One of the earliest clues to STC can appear soon after birth.

Meconium Delay

The first bowel movement after birth is called meconium – a dark, sticky substance made mostly of mucus that protected the baby’s intestines in the womb.

  • Most newborns pass meconium within the first 24 hours
  • A newborn with STC may not pass meconium until 24 hours or more after birth

Delayed passage of meconium often prompts doctors to investigate further for conditions like STC or Hirschsprung’s disease, especially at regional centers like Helen DeVos Children’s Hospital in Grand Rapids.

Common Symptoms of Slow Transit Constipation

Symptoms can vary from child to child and may change over time. In Grand Rapids, parents often first notice symptoms when toilet training or once a child starts school.

Most Common Symptoms

  • Infrequent bowel movements (going days without a bowel movement)
  • Chronic constipation that does not improve with standard treatments
  • Poor appetite
  • Abdominal pain or cramping
  • Abdominal distension (bloated, swollen belly)
  • Uncontrollable soiling (stool accidents, staining underwear)
  • Nausea
  • Haemorrhoids (piles) from straining
  • Blood in the stool (often from fissures or haemorrhoids)

Less Common Symptoms

  • Episodes of diarrhoea (often “overflow” diarrhoea around hard, impacted stool)
  • Severe constipation leading to bowel obstruction in more advanced cases

Because West Michigan experiences long, cold winters and kids may be less active and drink less water during these months, constipation can be more noticeable or worsened seasonally. However, in STC, symptoms are typically persistent year-round, regardless of weather or diet alone.

Emotional and Social Impact

Slow transit constipation can severely affect a child’s mental health and social life. In school-aged children in Grand Rapids, this may show up as:

  • Constant anxiety about losing bowel control in public
  • Fear and embarrassment about their condition
  • Avoidance of school, sports, or sleepovers
  • Withdrawal from social situations
  • Depression and loss of self-esteem, especially if teased or bullied

Professional counseling and support can be especially helpful for children and families coping with these challenges.

STC and Hirschsprung’s Disease

Hirschsprung’s disease is another condition that affects the nerves of the bowel. It is characterized by a congenital absence of nerve cells (ganglion cells) in part of the rectum and/or large intestine.

  • In Hirschsprung’s disease, the affected segment of bowel cannot perform peristalsis, so stool stalls and cannot be pushed through normally
  • Symptoms include severe constipation, abdominal swelling, and sometimes complete bowel obstruction

Overlap With STC

  • STC and Hirschsprung’s disease can look very similar in young children
  • In some cases, both conditions occur together, making diagnosis more complex
  • Standard constipation tests may miss STC, so specialized evaluation is often needed

Because of this overlap, children with suspected STC in Grand Rapids are often referred to pediatric gastroenterology specialists or NID/STC clinics at tertiary centers like Helen DeVos Children’s Hospital for more advanced testing.

How Slow Transit Constipation Is Diagnosed

Diagnosing STC requires a careful medical history, physical exam, and specialized tests. In West Michigan, your child may be evaluated by:

  • A pediatrician or family doctor (first step)
  • A pediatric gastroenterologist (often at Spectrum Health / Corewell Health or Trinity Health Grand Rapids)
  • A continence clinician or specialist continence advisor

Common Diagnostic Tests

  1. X-ray of the abdomen

    • Checks if the bowel is distended with large amounts of stool

  2. Barium enema

    • A contrast liquid is gently introduced into the bowel via the anus
    • X-rays are taken to outline the shape, size, and function of the colon

  3. Colonic nuclear transit study (NTS)

    • The child swallows a small radioactive marker dose
    • The passage of these markers through the bowel is tracked over about three days
    • Shows how quickly (or slowly) stool moves through the colon

  4. Full-thickness laparoscopic biopsy

    • A minimally invasive surgical procedure using small incisions in the abdomen
    • Samples of the bowel wall are taken to examine the muscles, nerve supply, and neurotransmitters
    • This is not the same as a rectal suction biopsy used for Hirschsprung’s disease; it provides deeper information about neuromuscular function

  5. Comprehensive continence assessment

    • Conducted by a continence clinician
    • Reviews toileting habits, diet, fluid intake, and psychosocial factors

These tests help distinguish slow transit constipation from other causes of constipation and guide appropriate treatment.

Is There a Cure for Slow Transit Constipation?

There is currently no permanent cure for slow transit constipation. It is a chronic neuromuscular condition of the bowel.

However, many children improve significantly with a combination of:

  • Medical treatments
  • Bowel management programs
  • Possible surgical options
  • Emotional and social support

The goal of treatment in Grand Rapids clinics is to:

  • Improve bowel motility
  • Reduce constipation and soiling
  • Minimize the need for repeated enemas or washouts
  • Improve the child’s comfort, confidence, and quality of life

Treatment Options for Slow Transit Constipation

1. Medications and Bowel Regimens

  • Laxatives to soften stool and help it move through the bowel
  • Medications to improve bowel motility (prokinetic agents, when appropriate)
  • Regular enemas to flush stool from the rectum when needed

Your child’s gastroenterologist in Grand Rapids will tailor a bowel program to your child’s age, symptoms, and test results.

2. Interferential Electrical Stimulation Therapy

Some children with STC may benefit from interferential electrical stimulation therapy, sometimes studied under protocols like the TIC TOC treatment trial:

  • Gentle electrical currents are applied through the skin over the abdomen or lower back
  • The treatment is painless
  • May increase bowel motility
  • Can improve bowel emptying
  • May reduce the need for medications, washouts, or surgery

Availability of this therapy may vary; ask your child’s specialist at centers like Helen DeVos Children’s Hospital or other Grand Rapids pediatric GI clinics if this is appropriate.

3. Surgical Options

For some families in West Michigan, symptoms may be so severe that surgery needs to be considered. The type of surgery depends on:

  • Which parts of the bowel are affected
  • How much of the colon is involved
  • The child’s overall health and age

Common surgical approaches include:

Colostomy

  • The bowel is re-routed through an artificial opening (stoma) in the abdominal wall
  • A colostomy bag is fitted to collect stool
  • Sometimes this is temporary, to allow the bowel to rest or to manage severe symptoms

Appendicostomy (Malone or ACE Procedure)

  • The appendix is brought to the surface of the abdomen to create a small stoma
  • This is often done using laparoscopic (telescopic) surgery
  • Enemas or irrigations can be given directly into the appendix/stoma
  • Helps flush the colon regularly and reduce soiling episodes

In some children, too much of the bowel is affected by STC, making surgery less effective or not possible. In these cases, careful medical and supportive management is especially important.

Coping Strategies for Families in Grand Rapids

Living with slow transit constipation is challenging, but there are many ways to support your child physically and emotionally.

Support Your Child’s Emotional Health

  • Never punish or shame your child for soiling accidents
  • Remind them that their bowels are difficult to control and it is not their fault
  • Offer pull-up disposable nappies/diapers or other continence aids appropriate for their age
  • Allow your child to talk openly about their feelings
  • Consider professional counseling for your child and family members to address anxiety, embarrassment, or depression

Work With Your Child’s School

In the Grand Rapids area (including Grand Rapids Public Schools and surrounding districts), you can:

  • Develop an “action plan” with the school
  • Identify a trusted teacher or staff member to help at toilet times
  • Ensure easy access to toilets and, if possible, a private bathroom or shower
  • Arrange for discreet storage of spare clothes or continence products

Connect With Support and Resources

  • Join a support group for families dealing with pediatric continence issues, such as national organizations or online communities
  • Ask your child’s care team about any local or regional support groups connected with Helen DeVos Children’s Hospital, Spectrum Health, Trinity Health Grand Rapids, Metro Health, or Mercy Health
  • Reach out to the Kent County Health Department or Grand Rapids Public Health for information on children’s health programs and mental health resources

Seasonal and Local Considerations in West Michigan

Grand Rapids’ climate—cold, snowy winters and warm, humid summers—can influence bowel habits:

  • In winter, children may drink less water, be less active, and eat heavier comfort foods, all of which can worsen constipation
  • In summer, higher activity levels and better hydration may help, but STC typically does not resolve with seasonal changes alone

Regardless of the season, maintaining:

  • Adequate fluid intake
  • Fiber-appropriate diet (as advised by your child’s gastroenterologist)
  • Regular physical activity

can support overall bowel health, though they cannot cure STC on their own.

When to Seek Medical Help in Grand Rapids

Contact a healthcare professional if your child:

  • Has persistent constipation that does not improve with basic measures
  • Goes many days without a bowel movement
  • Has severe abdominal pain or swelling
  • Has vomiting, especially green (bilious) vomit
  • Has blood in the stool
  • Has ongoing soiling accidents and emotional distress

Local Professionals Who Can Help

  • Your primary care provider (pediatrician or family doctor)
  • Pediatric gastroenterologist (e.g., at Helen DeVos Children’s Hospital / Spectrum Health, Trinity Health Grand Rapids, Metro Health, Mercy Health)
  • Continence clinician or pediatric continence nurse
  • NID / STC Clinic at Helen DeVos Children’s Hospital
    • Tel. (616) 555-0200 (example number)

They can coordinate advanced testing, create a personalized bowel management plan, and connect you with local resources.

Key Points About Slow Transit Constipation

  • Slow transit constipation is a neuromuscular problem of the large intestine caused by abnormalities of the enteric nerves and neurotransmitters.
  • The unusually slow movement of stool leads to chronic constipation, infrequent bowel movements, and uncontrollable soiling.
  • Most common symptoms include poor appetite, abdominal pain, bloating, and infrequent bowel movements; less common symptoms include diarrhoea and severe obstruction.
  • STC can often be diagnosed soon after birth, especially if meconium passage is delayed.
  • STC may mimic or coincide with Hirschsprung’s disease, making specialized testing important.
  • Diagnosis may involve x-rays, barium enema, colonic nuclear transit study, and full-thickness laparoscopic biopsy.
  • There is no cure, but treatment options include medications, bowel regimens, electrical stimulation therapy, and surgery (such as colostomy or appendicostomy).
  • Quality of life can be severely affected, but with expert care in Grand Rapids and strong family and school support, many children can achieve better bowel control and improved confidence.