Our 2-year-old daughter has repeated problems with constipation. We have tried a number of medicines, which do help, but as soon as we stop them she becomes constipated again with very hard bowel actions like pebbles and sometimes there is blood on them or the toilet paper. We can see that she holds back on using her bowels because of fear that it will hurt which it often does. What is your advice?
This is a miserable problem for your daughter. The blood suggests that she has a crack in her anus (technically called a fissure-in-ano). When this is torn open by the hard bowel action it hurts so that she is reluctant to do the job.
There are two steps I would suggest:
Firstly use one of the medications that has worked again but for 3 months! Ask her to go and try to use her bowels after the 3 major meals.
If she fails to pass anything for 24 hours then increase the dose – I usually recommend doubling the dose. If that fails then she needs a suppository or enema, which your pharmacist can give you.
Secondly I recommend some anaesthetic ointment put on at least twice a day – after her bath and then about 12 hours later. This is applied to the anus and does not have to be inserted, just put it on the surface. This is to stop the passage of the bowel action from being painful. Once the process is painless you can stop the ointment.
I strongly emphasise the importance of continuing the use of medicine for 3 months even though she may seem cured much earlier. Towards the end of the 3 months you can try reducing the dose say halving it for a week. If there is any failure to use the bowels for 24 hours, double the dose again.
This is a difficult and complex matter and I would be only too happy to answer supplementary questions. Best of luck.
2 comments:
My son is experiencing his first of what i suppose would be constipation. He is complaining periodically throughout the day about his bottom. I only say his bottom because he doesnt want anyone or anything to touch his butt. i tried putting him on the toilet and just waiting but he wants off. He's crying and wants to soak in a bath. Of course i let him. Tell me what to do.
This sounds as though he has a fissure in ano or a crack where the anus meets the skin. This is a painful condition especially when he goes to use his bowels.
It would be best if you could look at his bottom to make sure that there is not a rash surrounding the anus because a Strep. infection in this area can also cause pain and this requires antibiotics.
If he refuses to let you inspect his anus, you can buy an anaesthetic ointment to apply to the anus twice a day and before he tries to use his bowels. He can do this himself. This will ease the pain and he should be able to use his bowels. If not the addition of an oral medication to make him go will be needed. Your local pharmacist can supply these for you.
If this fails it is off to your pediatrician who will probably insist on looking at his anal region.
Best of luck.
David Robinson
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