To find a cure for anal fissures - Poor DS :(

[RedRose55]

I’m completely fed up. DS is 3.5. He started having hard pellets like poop around 6 months ago. Around the same time we started noticing tiny specs of blood on the toilet paper. It was diagnosed as anal fissures. He is on 5ml lactulose to soften poop while his fissures heal on their own. While lactulose helps soften poop, he is STILL bleeding when he goes. We then were given Movicol. His prob is not “moving” it, IFKWIM. He has a BM every day.

Has anyone faced this before with your DC? What did you do? I’m worried sick about how much damage is happening there as it has been bleeding for 6 months :( Tiny amounts, but def there.

If they’re not healing, return to the doctor and ask to discuss the potential for a lateral internal sphincterotomy. It’s an operation, so quite a serious step, but you bringing this up will hopefully push them into offering a stepped up solution that helps your son without the need for surgical intervention. I hope your son feels better soon, it must be very stressful.

I’m so worried about him. It’s not healing and I don’t know why. Even with lactulose, his poops are sometimes hard :(
He eats well. Gets his multivitamins. I give him a ripe banana every day. He drinks diluted juice, eats fruit etc.

Is there anything I can give or change or avoid that can resolve this for him?
If anyone here had this problem with DC, please please can you tell me what finally resolved it for you? I’m desperate :(

Sorry to hear about your DS.

Definitely keep speaking with your GP about the symptoms. What does a normal day's meals look like for your DS?

I suffered constipation all of my childhood and adult life. I suspected milk and had an lactose test but that was negative. I suspected meat and went vegetarian but that didn't help much (still eating eggs and cheese)

I discovered later that proteins in animal products could be the culprit and 18 months ago I went plant based. Not once have I been constipated since and six months into the diet all of my painful side effects have healed up too. It's made such a difference to my life.

I would suggest keeping a food and symptom diary in case you can join any dots. Obviously, I wouldn't advise cutting large food groups out of your little one's diet without proper planning.

There are many resources on the internet if you need to make changes and your GP can help with that too.

In my experience I felt that eating fruit made things worse for me. I would get a blockage and the fruit would sit behind it and give me terrible wind pains and force the blockage through and damage me in the process. The same for the fybogel and lactulose I was prescribed.

Doctors learn very little about food and nutrition during their training.

Good luck OP.

What does an average food day look like? I wonder if that’s a first step to try and tackle to get more fibre in. Sorry if that’s totally obvious.

Surely the bananas will make things worse- they can cause constipation because of the potassium in them.

DD used to be like this. There was blood in every bowel movement and the doctors didn’t seem concerned. She used to get terrible constipated. Thankfully at 4 she has outgrown it.

The one thing that cured my constipation was 3 litres of water every day.
Don’t give your little one 3 litres because that’s too much for a child but give him the recommended amount of water for his age or just slightly over.
I’d also recommend fibre 1 brownies which are fairly small but contain around 5g of fibre.
Raspberries are very very high in fibre.
You could also try and mix some linseed powder into a yoghurt

@daisypond ripe bananas are bad for constipation but if they’re very ripe, they’re very good for digestion

You have my sympathy, my dd1 had anal fissures and it was awful.

What worked for us was increasing the amount of fluid drank and using movicol. If a single satchet of movicol isn't making their poo soft then you can keep increasing the dose until it does. All movicol does is suspend fluid in the gut, so taking loads does dc no harm.

I suffered with anal fissures as a teenager. After a year of torture I was finally offered an operation (probably the lateral internal sphincterotomy mentioned above, I don't recall it's exact name). I haven't had any significant issue since.

I had a very small issue a few years ago (about 15 years after the op) but I got the anusol cream and knew I had to keep my stools 'soft' so I upped my water intake. The surgeon who operated advised me to keep drinking water - at least a large glass an hour.

The worst aspect of this is that it hurts to open your bowels so you don't want to. This then leads to impacted poo which becomes even harder and more painful to pass - therefore making the problem worse. It's a vicious cycle.

Lactulose and drinking water do help. As does finding any foods which naturally help produce loose bowels - this is very individual. For me this is probiotic yogurt, olives and prawns (not all in one dish!).

I don't know if anusol cream can be used on a 3.5 year old but it's worth asking your GP (sometimes medicines can be given even though the packaging suggests not). Anusol cream can really help soothe the area so provide some relief while it heals.

I really feel for you and your poor DS - anal fissures are horrible and can really impact on day to day life.

Drink a lot of fluids. Also i was given a suppository that increased blood flow to the area which aided healing. I will try and find the name. And actually they hurt so much that an anelgesic makes you relax rather than clench.

I might have musubderstood the suppositiry. It was called proctosedyl - it was brilliant

Fruit doesn’t contain much fibre, which you need to retain water in the stool and keep it soft.
Your DS should be eating plenty of whole grain fibre and green vegetables to achieve this.
Also, is this a new problem or has he been like this since birth? There are conditions such as Hirschsprung’s, where a segment of bowel doesn’t contract properly, to move the stool along, resulting in intractable constipation, hard stools, and then fissures when the by now practically concrete stool is finally expelled.
Try experimenting with diet to see if you can improve the situation. There are also creams that relax the spasm caused by the fissure pain and promote healing. Certainly return to the GP if DS is no better.

Don't beat yourself up too much over his diet, as long as he eats a range of foods. Some people are just prone to problems in this area - me included. It runs in our family.

Drinking loads will help. Encourage him to go when he needs to and not hold it in. Not missing meals makes my issues easier too, for some reason. If things get really tricky, apricots are my fibre food of choice, either dried or fresh, as they're easy to eat. They are sugary, but they're much more palatable than prunes. Just be vigilant with teeth cleaning.

Bananas cause constipation OP....not cure it!

Oranges or prunes would be better. Who told you to give him banana??

Would he eat something like flapjack, loaded with Figs, or other dried fruit?
Fruit with plenty of fibre- satsumas etc.

Prunes are great, if he wouldnt eat them as they are, could you puree them, over ice cream, as a sauce? More sauce than ice cream!

Its a vicious circle- poo-ing dry hard poo causes anal fissures, so you dont want to poo, so the circle then goes round again

There are two kinds of fibre- make sure he's getting both- and lots of water. Also try upping fat. Cream with stewed fruit is very palatable!

Give up the banana, as it isn't doing it's job.

Keep a food diary and play with things like porridge and weetabix, as well as fruit/veg fibre like prunes, apricots etc.

Foods he might like which help
Fig rolls
Fruit bars
Popcorn

Totally agree re pain relief.

My dd was withholding poos because they hurt to pass because of the fissure, and she was too small to reason with. She had to have a high enough dose of movicol so that she couldn't hold it in, because it was so loose.

The other thing that helped us was letting the dc have squash to drink. I had always planned for the dc to only have water or milk, but I found I couldn't get them to drink the quantities of fluid they needed. I know squash has downsides, but for us it was better than the pain the dc were in.

My DS has the same issue at a similar age. I do remember them taking quite a long time to heal properly (the GP said they probably would just due to the placement of it), but I don't think it was as much as 6 months.

He had lactulose and prunes in a smoothie, which worked well to soften, but the think that worked best afterwards for keeping stools nice and soft and being very regular was adding a pro-biotic into his diet.

Henny why do you think bananas cause constipation? Googling suggests it’s only green bananas that would.

Thanks everyone. We are a vegetarian family. DS typically has :
Breakfast: A small ripe banana, a cup of milk and one of these (cereal, toast, porridge)

Mid morning snack : Some biscuits/ crisps/ ice cream or whatever he likes

Lunch: one of these (Wholemeal veggie sandwich / pasta/ rice+curry ) with yogurt

Afternoon snack: half an apple with biscuits breadsticks or similar. He loves satsumas, so has 1 everyday

Dinner: Rice with veg (egg 3-4 times a week)

5ml lactulose and wellbaby multi-vitamin liquid.

He doesn’t seem to be in pain or even straining to pass poop. I ask him all the time if it hurts. He says no. But there is blood when I wipe :(

Hi OP, can you add any more protein in? I may have misunderstood but for dinner, is he just having rice and veg and egg three times a week?

@HennyPennyHorror very ripe bananas are beneficial for people with constipation. It’s the unripe ones which are detrimental

@FrancesFlute: yes. It’s more like veggie fried rice (with egg sometimes). I forgot to mention - he has yogurt too with dinner.

Also, he has a handful of mixed nuts every day (usually around snack time)