“wondering if there’s anything else I can do about my 7yr old daughters constipation. It’s going on 3 weeks now, she cut her bum when going poo. Chemist gave me Ducolax for her, used that for 2 weeks. When in my sisters last week she used an enema (right word?) still nothing. Doctors then on Monday was prescribed Laxido got 1 into her and she eventually went a little but she will not drink it again. I’ve had to keep her off school as she’s holding it in and completely contorts her body in pain. She is also soiling herself. Unsure what to do next. She eats weetabix or shreddies every morning, plenty of fruit & veg and fluids. Thanks”
When docs hear “Cut her bum going poo”, we worry about anal fissure. This is incredibly painful injury that happens when your child pushes out hard, constipated stool.
The pain of the fissure makes your child hold in poo, the constipation gets worse, then passing it through the injured anus is agony, and creates a miserable cycle of abdominal pain, constipation, anal pain. This can lead to ongoing problems with your child’s bowel habit.
Work with your GP. Ultimately, you might need a paediatric surgeon to help if it is not settling.
We talked about constipation recently, but it’s so common. It is well worth discussing again because it is not harmless in children. It can cause them so much discomfort!
Chronic abdominal pain of all sorts, crampy or achy, in children is common, and there are many, many, many reasons besides appendicitis.
So, back to the GP and work with your doctor. This will also take some thinking on your part to help your doctor. When is the pain the worst? What makes it better? What makes it worse? Does it interfere with sleeping? With playing? Any other symptoms? Your doctor will ask about her stool: how frequently? Hard or soft? (Not sure about how to describe your child’s stools? Never fear! Try using the Bristol Stool Chart !) Difficult to pass? Is the pain related to when she needs to pass urine?
What things will your doctor be thinking about?
The commonest cause for this is constipation, accounting for around 13% of children who present with ongoing abdo pain with no other worrying features like fever or weight loss. These children inevitably end up in hospital and see a doctor like me. Every day, in every GP surgery, ED, and surgical clinic, children are presenting with abdominal pains due to constipation. So common (and preventable/treatable!) And so many times, without fail, the mothers tell us the child isn’t constipated. We always do get there in the end.
What is constipation? Doctors usually consider treating constipation when patient says that they have trouble with bowel function, such as stools that are too hard or too small, complain that passing stool is too difficult or infrequent (usually fewer than three times per week.) But there are some important differences when we think about age. Causes, investigations, and treatment are very different in the toddler, the middle aged adult, and the older adult. We will stick with children this morning.
Important bit of #mythbusting: Can you still be constipated even if you have gone to the toilet? Yes, you can definitely be constipated even if you have gone to the toilet. Is it an urban myth that if you have diarrhoea you can’t be constipated? Actually, it’s one way that very bad constipation may present to the doctor: overflow diarrhoea is watery stool that passes around impacted hard stool in your colon.
There are many other common and easily treatable things that should be thought of, including anxiety, heartburn/reflux or urinary tract problems.
Less likely but commonly blamed? Food intolerances. If you suspect a true food allergy or intolerance, ask your GP for a referral to a a CORU-registered/INDI-registered dietitian and appropriate paediatric specialist. I say it alot here, but can’t say it enough: Diets excluding foods like dairy or gluten are not safe for children unless they are under the guidance of a specialist: A “nutritionist”, chiropractor, kinesthesiologist, or osteopath is not qualified to recommend dietary changes in an infant or child, which was the driving force behind CORU-registration.
Trying your best to make sure your child gets enough fibre? If you need expert help, ask for a referral to a INDI and CORU registered dietitian. Want to estimate it yourself? Just a little math and some label reading: Add age of child plus 5 -10 grams per day. So, for a 4 year old, aim for 9 – 14 grams a day. (This will require label reading, and sometimes, a fibre supplement.) Remember, the increased fibre intake won’t work without increasing (non-milk!) fluids. This “Fabulous Fibre Factsheet” from INDI is for adults, but give good advice on sources of fibre:
https://www.indi.ie/…/Fabulous_fibre_fact_sheet_2.pdf
(The www.indi.ie website is a great trusted source for nutrition and also has a list to help you find a registered dietitian.)
If your GP can’t get to the bottom of it (pun intended), s/he will probably refer you to for a consultant opinion.
For other mammies, when should you urgently book GP appointment for ongoing abdo pain in your child?
Bloody or severe diarrhoea
Unexplained fever
Urinary symptoms
Back pain with the abdo pain
Family history of inflammatory bowel disease
Black, tarry stools
abdo pain with new rash or ulcers in the mouth
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