13 Using Nutrition to Overcome Complications of Anal Stenosis
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Dynamic Chiropractic – February 1, 2013, Vol. 31, Issue 03

Using Nutrition to Overcome Complications of Anal Stenosis

By Van Merkle, DC, CCN, DCBCN, DABCI

"Your 6-year-old daughter may need a colostomy bag." Imagine being a parent facing this decision. What would you do? Aubrey spent the first few years of her life in and out of the hospital, facing two surgeries, several biopsies, misdiagnoses and an uncertain future.

She was born with anal stenosis – a narrowing of the anal sphincter and opening that makes it difficult for stool contents to be eliminated.1 Unfortunately, this birth defect (which can be fixed with surgery) was missed.

In fact, this defect was overlooked for almost three years. She spent hours trying to pass bowel movements and had frequent accidents once toilet trained. The constipation left her with a significant protruding stomach and constant abdominal pain. Every few weeks, Aubrey was back at her doctor's office due to the constipation. She was misdiagnosed with Hirschsprung's disease, placed on laxatives and given Hegar dilators to try and enlarge her anal opening, and also underwent two anoplasty surgeries. Amazingly, medical doctors never discussed changing Aubrey's diet or food intake with the family; all they said was to eat fiber.

By the time she was properly diagnosed at age 4, years of constipation had led to a severely enlarged colon from fecal compacting (three times the size it should be in some areas) and the doctors insisted they needed to remove portions of the colon, and possibly attach a colostomy bag until her bowel contents were able to pass through the remaining colon effectively. They said this was the only way to "live a close-to-normal life."

However, during the surgery, the doctor opted not to remove the colon at the last minute, and instead fixed the birth defect and opened her anus to the normal size of a 4-year-old child. A year after surgery, the doctors were "amazed" at how well Aubrey was doing. She started kindergarten (although she missed a lot of school due to constipation, cramping and bloating), suffered frequent bowel accidents at school, lost control of her bowels while running and playing, still showed a protruding stomach and bloating, and had now developed anxiety about having accidents in public. At age 5, she learned to keep a spare change of clothes at school and often came home with soiled clothes in a plastic bag. As a parent myself, I can only imagine how difficult and embarrassing this must have been for Aubrey.

Yet the doctors were happy with her progress. They planned to keep her on laxatives the rest of her life and hoped she would "eventually" be accident free. Aubrey's mom worried that her daughter might develop an eating disorder because children with digestive issues often relate eating to stomach pain. Doctors also prepared the family that if she didn't keep up good progress, they might need to remove sections of the colon after all.

Her mom was happy that the original problem was fixed, but truly believed her daughter did not need to live with a bloated stomach and accidents. She was not satisfied with what the doctors were satisfied with – she wanted her daughter to be healthier.

So, I pose this question to chiropractors: Is there anything you could do to help this child? Of course! The initial problem (the birth defect) was fixed with surgery, so the remainder of her problems are side effects in the colon and intestines from scar tissue and years of chronic constipation and treatment. Nutritional help was essential for this young lady.

After her consultation, I ordered a full diagnostic work-up to see what areas of the body were not functioning optimally: blood tests (glucose levels, comprehensive metabolic profile, liver panel, lipid panel, thyroid panel, complete blood count, erythrocyte sedimentation rate, c-reactive protein, creatine kinase and vitamin D 25-hydroxy) hair analysis (toxic elements and essential elements), basic urine dipstick and blood occult stool test. I didn't expect a lot of bad results to appear; however, it is essential to thoroughly check the body for additional problems before making nutrient and dietary recommendations to ensure nothing is missed.

As expected, no crises appeared in her tests. She had very low vitamin D levels, signs of a mild infection and some signs of toxic element interference. This was not surprising because her mother said the child suffered from chronic colds and other infections, and often had trouble sleeping.

The next step was to evaluate her diet. Whenever you eat food, hydrochloric acid and enzymes in your stomach begin to break down the food into absorbable forms. The food is then passed into the small intestine, where it's further broken down by enzymes and bile, and the sugars, amino acids, fatty acids, vitamins and minerals are absorbed through the intestinal lining and transported to the blood. Once the intestines have pulled out all the nutrients, the indigestible, watery remains move into the large intestine. The large intestine absorbs the water and sends the remaining dry mass out of the body as feces through the rectum.2

When you take laxatives and stool softeners, they work to add moisture to the food being digested (which makes it softer and looser) while in the intestines, and stimulate muscle contractions to encourage the mass to continue moving through the intestines.3 However, this can inhibit your body's ability to absorb nutrients ,and can also train your body to stop contracting and pushing the stool out on its own. Aubrey had been on laxatives for years, so it's very possible that her body was nutrient deficient, which may have been causing the chronic infections and illnesses. Thus, increasing her vitamin and mineral intake was very important.

Staying hydrated is essential for keeping the stool soft and easy to pass. Bulking agents (fiber) are also helpful so the stool does not gather in expanded areas of Aubrey's intestines. There were some simple substitutions we could make to make her average diet (see table) more nutritional.

Aubrey's Diet Prior to Nutritional Counseling
  Breakfast Snack Lunch Snack Dinner Snack Water Intake
Day 1 2 scrambled eggs; orange juice; banana Pretzels; juice pack Crackers; carrots with ranch dressing, 2 turkey slices; chocolate chip cookie Jell-O Chili soup (beef, squash, corn, green beans and cheese) Crackers; skim milk 6 x 10 ounce glasses
Day 2 Toast & jam Chips; strawberry-banana smoothie Peanut butter & jelly sandwich; zucchini with ranch dressing; banana; chocolate chip cookie Salad with ranch dressing; V8 Splash Pepperoni pizza Granola bar; skim milk 4 x 10 ounce glasses

  • Replace the peanut butter and jelly with almond butter, which is more nutritious, and honey, which has good anti-bacterial properties.
  • Instead of pretzels, crackers, Jell-O, etc., keep a supply of chopped veggies, fruit, mixed nuts, sunflower seeds, etc., on hand; you never have to worry about hydrogenated fats or other unwanted ingredients, and they are full of protein and nutrients.
  • Dairy products are difficult to digest, mucous-forming, tied to allergy symptoms and constipation, and may come from cows treated with hormones and antibiotics. Switch to almond milk or coconut milk, which taste similar but are more nutritious, and leave cheese off your pizza; instead, add a few veggies as toppings, like fiber-filled spinach and vital protein like diced chicken.
  • Most importantly, take away the temptations. Don't offer unhealthy foods or even keep them in the house; set an example for good eating habits and be consistent.
  • Kids are smart; if you explain why you are cutting out certain foods, they will understand why – and even help you read labels at the grocery store.

Supplementing her diet was also important:

  • Digestive aides – acidophilus, S. boulardii and glutagenics (glutamine, deglycyrrhizinized licorice and aloe vera) to support the gastrointestinal lining and improve digestion of food.
  • Green drink – to supply an extra level of nutrients daily, which will also help eliminate toxic elements.
  • Fish oil, vitamin D and vitamin C – to boost her immunity and work to eliminate the signs of infection seen in testing.

During the first three weeks following the above recommendations, Aubrey's mom noticed her daughter's abdomen was less bloated. Her pants started to fit her around the waist. "It was like magic; really amazing!" Aubrey became more confident as she had fewer and fewer accidents. Her teacher noted, "She has been much more confident in her work, is smiling a lot more, and she seems to be much more upbeat, awake and focused." In this case, how the patient feels is one of the most important results. Moving toward less frequent accidents, missing less school, and gaining confidence are phenomenal results.

After fearing a future of colostomy bags, this child has now gone months without an accident. She no longer suffers from chronic colds and infections, sleeps well through the night, and is playing and acting like a typical 6-year-old. Only she's not so typical, because after her hospital experiences, Aubrey created an organization called Jellyfish Wishes that collects and makes thousands of cards and get well-packages each year for hospitalized children.4 With a great diet, lots of support and the joy of Jellyfish Wishes, Aubrey has created a much better future for both herself and her family.


  1. Birth Defect Risk Factor Series: Anal Atresia-Stenosis. Texas Department of State Health Services, June 2007.
  2. Your Digestive System and How It Works. National Digestive Diseases Information Clearinghouse; U.S. Department of Health and Human Services, April 2008.
  3. "Over-the-Counter Laxatives for Constipation: Use With Caution." Mayo Clinic, April 23, 2011.
  4. For additional information visit www.jellyfishwishes.com.

Dr. Van D. Merkle, president of Science Based Nutrition, is a diplomate of the American Clinical Board of Nutrition and the American Board of Chiropractic Internists. He is also a diplomate of the recently formed Chiropractic Board of Clinical Nutrition and currently serves as vice president. Dr. Merkle has practiced in the Dayton, Ohio area for more than 25 years, and hosted the call-in radio talk show "Back To Health, Your Guide to Better Living" since 1995.

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