Help me diagnose this!

[Ozgirl75]

So, I have been to the Dr with my son (12) but I’m not convinced in the diagnosis (and she didn’t seem sure at all either) so any ideas what could be causing this:
Dull but bad pain around the anus after bowel movement which lasts on and off for a couple of hours
A feeling of it not being fully empty or clean (it is clean)
mild stomach pain
The pain is so bad at first that he can’t even sit down.

He isn’t constipated, no blood, no stinging pain, no sickness or fever. He did have a loose stool this morning but no urgency and I wonder if it’s because we’ve increased the fruit and veg.

She has said maybe a mild case of hard faeces impaction and has said movicol twice a day to clear him out. We will of course do this, but he’s never been constipated, he poops every morning, he has a good diet, drinks water, is active, doesn’t complain of tummy ache or anything.

So can you get this faecal impaction after never suffering from constipation before?

it’s really stressing him out as he worries that if he has to poo at school, it will be really painful and he won’t be able to do any of the things that relieve it, like moving around or not sitting down.

Any help would be greatly appreciated!

You can absolutely be constipated despite going every day - if you aren't emptying a sufficient quantity then it will back up. That's not to say nits definitely that but it seems a v reasonable starting point.

If he needs to go at school and ends up in pain can you reassure him that he could go to the nurse and explain the situation (maybe you explain preemptively even to ease his anxiety) and it will be fine. Poor kids, sounds like he's quite stessed by it which probably makes the whole thing so much worse.

I actually did email the lovely school nurse today to say exactly that and she said he could go in anytime for a lay down if he needed to. His class teacher is a bit of a dragon and I think he fears asking to go there in class.

That’s interesting that you can be constipated if you don’t fully empty. I guess we’ll do the movicol and see if that assists things. Can they check for this any other way? Ultrasound or anything? He doesn’t have a sore or bloated stomach and it doesn’t hurt when he presses it. I’ve had constipation (the traditional type where you just can’t go!) before and I feel miserable with it but my DS says he’s never had this pain before.

Did the Dr check for hemorrhoids? You can have internal ones or external ones. They can be quite painful.

All these symptoms can be signs of fissures or hemheroids too, so worth getting them to check for that. But constipation does sound likely and is a cause of both.
Does he eat enough fibre?

I had similar recently. Feed him quinoa and lots of veg for a few days. Sorted me right out!

The Dr did check for external tears or haemorrhoids, but said they don’t normally manually check children for internal ones as it can cause more damage and it would be the same treatment anyway (movicol and cream).

DS said that until a couple of days ago his poos were no different to normal. He has fruit in the morning and at recess, multigrain bread, lots of veg for dinner. He even has one of those date and nut balls which I think are great at keeping things regular. The weather has suddenly warmed up here so he’s possibly a bit dehydrated but he does drink water as he’s often playing sport.

I guess I’m just a bit concerned as he’s never seemed constipated although his poo “style” is different to mine where I’m in and out in about 4 minutes normally whereas he sometimes sits there for a while, but I think that’s just because he’s not in a rush with life like I am.

He really likes quinoa so that’s a good suggestion!

Stress is definitely not helping. I went to take him to school mid morning today as he was feeling a lot better and on the way, the pain got much worse and when we turned round it got better.
He’s not having me on, he loves school and it was his idea to go in, but I think the worry of “bum stuff” at school is stressing him out.