Cerebral Palsy and Gastrointestinal Symptoms

About 90-92% of individuals with cerebral palsy (CP) have clinically significant gastrointestinal symptoms (1, 2).

Impaired oral-motor function is a common issue in individuals with cerebral palsy, and can lead to vomiting, aspiration pneumonia, gastroesophageal reflux, temporomandibular joint contractures, and hypoxemia. These conditions in turn can increase the time taken to eat meals, fatigue associated with mealtime, and malnourishment (3). Therefore, each element of oral and digestive function affects the next; many of the gastrointestinal symptoms associated with cerebral palsy are related to each other.

In general, gastrointestinal symptoms associated with CP are caused by such issues as the following (3):

• Abnormal autonomic control of gastrointestinal movement
• Inadequate oral intake of food and/or drink
• Prolonged colonic transit
• Delayed gastric emptying
• Impaired oral-motor functions

The following is a list of the primary gastrointestinal symptoms associated with cerebral palsy, including constipation, abdominal pain, swallowing issues, and gastroesophageal reflux and/or vomiting (1).

Constipation

Roughly 74% of people with cerebral palsy experience constipation (4). It can be caused by low movements of the body, dysphagia leading to low food or water intake, rigid abdominal muscles causing slower peristalsis (the movement of food in the intestines), and poor coordination of the muscles around the anus (4,5).

Other issues with constipation may result from poor-seated posture often associated with atypical skeletal muscle tone or difficulty getting into a position that would aid in release of bowels. Additionally, because standing upright and exercising are two things that aid bowel movements, individuals who experience difficulty with either will struggle more (5).

There are many ways to help with constipation, including (5):

• Laxatives
• Stool softeners
• Suppositories
• Increased physical activity
• Increased clear fluids
• Increased fiber in diet
• Gastroesophageal reflux and vomiting

Roughly 50% of people with cerebral palsy have gastroesophageal reflux and/or vomiting (1). Reflux is associated with other conditions commonly experienced in individuals with CP, including (6):

• Spasticity
• Scoliosis
• Difficulty swallowing
• Long periods of lying on the back

About 32% of people with cerebral palsy experience vomiting or regurgitation (2). The vomiting is usually a result of gastroesophageal reflux. It can also be caused by gastric dysrhythmias (abnormal gastric antral contractions). In either case, treatments include medications, surgery, and nutritional support.

Abdominal pain

Roughly 32% of people with cerebral palsy experience abdominal pain (1). This pain can vary in causes, including gastro-esophageal reflux, spinal deformity (scoliosis), and changes in muscular function in the esophagus or lower esophageal sphincter (7).

Difficulty swallowing

About 60% of people with cerebral palsy have swallowing disorders (1). Dysphagia is a persistent difficulty or pain when swallowing. It has been found that between 19-99% of people with cerebral palsy report dysphagia (8).

It was also found that more than 50% of the children in a major study with spastic cerebral palsy experienced post-swallow inhalation (8). These studies reveal that there are many different physiological elements involved in swallowing, whether that be abnormal breathing, swallowing coordination, or voluntary cough effectiveness. Children with CP have a more difficult time with each of these elements, and synthesizing them to safely swallow food is an even more challenging process. Read more about dysphagia and cerebral palsy here.

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1. Glader, L., & Barkoudah, E. (2019, October 30). Cerebral palsy: Clinical features and classification. Retrieved February 15, 2020, from https://www.uptodate.com/contents/cerebral-palsy-clinical-features-and-classification?search=cerebral palsy and digestive&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
2. Del Giudice, E., Staiano, A., Capano, G., Romano, A., Florimonte, L., Miele, E., … Crisanti, A. F. (1999, July). Gastrointestinal manifestations in children with cerebral palsy. Retrieved May 2, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/10413017
3.  Krigger, K. W. (2006, January 1). Cerebral Palsy: An Overview. Retrieved May 2, 2020, from https://www.aafp.org/afp/2006/0101/p91.html
4. Faleiros-Castro, Santana, F., Paula, & de, E. D. R. (n.d.). Constipation in patients with quadriplegic cerebral palsy: intestinal reeducation using massage and a laxative diet. Retrieved May 2, 2020, from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342013000400836&lng=en&nrm=iso&tlng=en
5. The Neuromotor Link: Constipation in Children with Neuromotor Disabilities . (2005). The Neuromotor Link: Constipation in Children with Neuromotor Disabilities . Retrieved from https://www.dhhs.nh.gov/dcbcs/bds/sms/documents/constipation.pdf
6. Pediatrics, D. of. (n.d.). Diagnostic and Therapeutic Approach to Vomiting and… : Journal of Pediatric Gastroenterology and Nutrition. Retrieved May 2, 2020, from https://journals.lww.com/jpgn/fulltext/1997/00002/diagnostic_and_therapeutic_approach_to_vomiting.17.aspx
7. Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data. Retrieved June 28, 2023, from https://pubmed.ncbi.nlm.nih.gov/32061920/
8. Malhas, A. (2018, October 15). Difficulties in Swallowing and Coughing in Spastic Cerebral Palsy.. Retrieved May 1, 2020, from https://cerebralpalsynewstoday.com/2018/10/15/difficulties-in-swallowing-and-coughing-in-spastic-cerebral-palsy-study-focus/