Risperidal and bowel incontinence

[deltaforce]

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Hello folks,

I wonder if anyone knows/understands more about connection between Risperidal and bowel incontinence.

I met a parent whose child will be 8 in a couple of months. This boy is diagnosed with autism at age of 2.6. He lost well developed speech, eye contact and started with uncontrollable crying fits little before the diagnosis. Still the parents managed to potty train this child by age 3.5 He was fully potty trained until he was almost 5.

The parents tried to enroll their child in a special needs school (not in the US) at age 5. The school asked for a physician's report, who happened to be on the school's board. Before this, the parents never consulted any physician but were doing behavioral therapies religiously, to which the child was responding very well. Since the school needed a physician's report (I suppose, not an evaluation), the parents consulted this physician. To address his hyperactivity (which is a co-morbid condition), the physician prescribed Risperidal, 0.25 mg BID. Within weeks of starting Risperidal, the child lost bowel control. The parents continued Risperidal on physician's advice for about 3 months. At that mark, the parents felt that Risperidal is not helping with his hyperactivity, and bowel incontinence was causing lot of anxiety to the child. Risperidal was discontinued.

Now the child is almost 8 but still has not gained bowel control. There is no issue with the urine. As and when needed the child uses restroom all by himself, but bowel issues are a big mess.

Anybody knows why this side effect would stick around almost 3 years after stopping such a small dose of Risperidal? Another physician suggested, it could be mitochondrial dysfunction (which is again common in ASD population), but I don't understand the connection between these two.
Any insight in this business and any idea on how one can address this is welcome.

Many thanks in advance.

(P.S. - I don't really know if this is encopresis. My above post is from what I understood from the parents)

Edit: The dose edited to 0.25mg, and not 5mg. Apologies for the mistake.

 

[deltaforce]

You are right. 5mg is not a small dose. I am mixing it up with something else in his chart. I will update the dose once I talk to the parent. Till then lets assume, it was 5mg.

Actually, there is no 5mg tablet of Risperidal in that country (don't know why it didn't strike at the time of writing the post). They have only 1,2,3 and 4mg tablets, and the chart said one tablet BID. So I mixed up the dose. Apologies.

 

[genesis09]

I only know of one drug which has fecal incontinence as a side effect and that is Xenical. Risperidone has urinary incontinence and constipation as a side effect. That drug completely cleared the body a long time ago. Just remember correlation does not mean causation.

 

[Promethean]

Correlation is not causation.

The family has related the bowel incontinence to the risperidal , but there is no certainty that they were related at all. It is possible that the bowel incontinence would have developed no matter what. Because risperidal was prescribed, and then there was a change in the patient's function, the family assumes that the drug is to blame. The story makes sense to them, so they cling to it.

Was there really no episode of bowel incontinence prior to initiating the drug... none at all? Or is that just how it is remembered, because that makes sense? Maybe it happened exactly as described (not that this definitely implicates the drug as the cause!), or maybe it didn't. But getting the story 3 years after the fact, you have to consider at least the possibility that their memory of the chronology has been affected by the narrative they developed to understand what was going on, and may not be entirely reliable.

The child was only continent of bowel for around 18 months, if that. There was a major stressor in the child's life at the time that he became incontinent (starting school, disrupting the very routines which the family stated had controlled his condition up until that time.) This is a very different situation than if the patient were a neurotypical child who had been continent for years, where the only change in his life and routines were his medication regimen. Then, an association would be clearer.

In this case, it sounds as if the family has decided the drug was to blame, and has managed to convince you as well. I don't blame them. They'd very much like to find that something was a definite cause of the problem, because that would mean that there might be a simple solution. So, I also don't blame you for doing due diligence and investigating as far as possible whether there might be a simple way to help them. But have a little healthy doubt in your own mind. After all, falsely attributing the regression to the drug therapy might not only deprive the child of pharmaceutical support that could be genuinely helpful... but it might be distracting from finding the real cause and an actually effective solution.

 

[rph3664]

This child needs to see a pediatric gastroenterologist. Something else is going on here.

 

[BidingMyTime]

This child needs to see a pediatric gastroenterologist. Something else is going on here.

This. While it doesn't seem likely, I would have said its possible the risperdal was causing the bowel incontinence, but for 3 years afterward? I just don't see a way the risperdal would have permanently damaged the boys body leaving him permanently bowel incontinent. How verbal is the boy--can he articulate any reason why he doesn't have bowel control? It seems more likely that there is something pyschological going on. Presumably the boy stands up for urination, so maybe he is afraid of sitting down over a hole which is causing his bowel incontinence--possibly when he was younger, he didn't think about the hole, but as he got older and more aware of it and then became afraid of it. This is just one hypothesis, obviously there could be more, so the best bet would be to see what the boy can articulate about his problem. And certain any physical issues should be ruled out, which is why a pediatric gastroenterologist should be consulted.