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.

Call ERIC and get some advice from experts - if you haven’t already. Wish you and your son the very best RedRose.

It does sound a bit of a dry diet can you not get figs and prunes in there somewhere

For drinks, he has water with some juice (20% juice)

@slipperywhensparticus sure. I got some prunes today. Figs - I will get them too. Is it ok to purée them?

I think egg 3 or 4 times p/w may be a little binding ,Maybe 1 or 2 if hes having problems?,Also Carrot sticks.a little dip,some apple or pear slice up for snacks ?.Lots of water to drink .Maybe some weak sugar free squash?.Lots of exercise too (moves things along!).My DS and DD /DS have all suffered a bit like this too!

@pigcon1 thank you. What is ERIC?

You need the Movicol.

He may be having one bowel movement a day but if his motions are still hard, the fissures won't heal and he is still constipated.

He needs to be at a super soft, almost gravy-like consistency for aaaages. Constipation isn't just an overnight thing - for him to have had fissures he will have been constipated for months and it will take months of him being on laxatives making his motions very very soft to get back to normal again and teaching his bowel what to do again.

Give ERIC a call - they are the experts.

www.eric.org.uk

The children's bladder and bowel charity

My doctor said Movicol is better than lactulose so I'd give that a go.

He might be having too much egg and not enough water also.

Have a look at ERIC online there's plenty of info for you. Good luck.

If he's pooping every day but they're hard, the problem is not fiber- it's moisture content. He needs a lot more high water content fruit and vegetables- watermelon, strawberries, blueberries- and way less dry, binding food- limit toast, biscuits and crisps. He also needs to drink a lot more water- the purpose of juice for constipated kids is that the high sugar content encourages the intestines to contract and almost forces a bowel movement. Your son doesn't sound constipated- he sounds dehydrated.

When my son was badly constipated as a toddler, I was told by the pharmacist to completely avoid bananas until he was back to normal. I would definitely stop giving bananas and go back to the doctors as the bleeding is still ongoing.

I think you need more variety. For snacks, can you try dried fruit? Agree also that more liquid would be good - have you tried making him smoothies at home, with added yoghurt perhaps? It does feel that he's got a lot of carb type food. Would he eat things like veg stews with lentils or similar?

His diet sounds very dry to me and the carbs sound like they are low in fibre. Agree with dropping the banana.

We had persistent problems with fissures with DS2, though his issue was the opposite in that he didn't have a solid stool until he was five (it was the runny stools that were irritating/weakening the skin and causing the fissures rather than large solid ones tearing it). The GP gave him glyceryl trinitrate cream which helped enormously with healing, and significantly reduced the infection risk.

Though obviously you need to get the stools sorted as well so he doesn't just rip them open again!

OP, my DD had terrible anal fissures after her stoma was reversed. She was in so much pain and always bleeding having to learn how to poop out of her bum again. I tried this, and within 24 hours there was such an improvement. After a few days they were all gone. It's wonderful stuff for eczema and other skin conditions as well .
You can only buy it online, but it is so worth it. If you Google it you'll see all the wonderful reviews from happy people.

www.ebay.co.uk/itm/292767441946

www.buttpaste.com/

In addition to lactose and movicol GP prescribed Vagisan cream for my grandson. Thought it was a mistake at first but it has really helped. In your situation I would go back to GP for further advice .

We would put a cotton bud with a smear of vaseline or lub on it just inside the child's rectum to help the passage out. If I was you I would also ask dr to switch to movicol as a stool softner. My daughter had bowel issues for 7 years - we tried all the stool softners including a alchol based chocolate option! Movicol best for long term and easier to play around with the doses.

One doctor did also prescribe a anthestic gel which they use in the throat to which I could use for my daughter. Another had her in the surgery and put in the enimas which change everything to liquid - you can get these over the counter in some european countries but only on prescription in the UK.

Bananas are not your friend here, nor the egg. Tbh, it's a very carby diet.

I had one after giving birth. It was worse than giving birth so I feel for your son.
Loads of water, upping fibre rich food so high fibre bread, prunes, leafy veg (if he'll eat it), exercise (so a long walk or good run round the park) and going as soon as he feel likes he needs a poo. I was on movicol for months.

Sadly my tried and tested two coffees and half a bottle of red wine cure isn't suitable for him.

Drinking loads help. Lots of fibre too. I'd skip the bananas and eggs until things improve.

Totally agree with @AnnaMagnani at 15:14

Lactulose isn’t particularly effective IMO, and 5ml is a low dose so I’m not surprised he’s still having hard poo, especially if his issue is slow transit constipation. Movicol is the first line treatment and much more effective. And it’ll have to be a high enough dose to produce mushy poo (like a type 6 on the Bristol stool chart) for months and months. Only then will the fissures start the long process of healing. Every time he has a hard poo he goes back to square one.

Try Hydromol. It's a paraffin like emollient and really helps keep the skin supple. Worked a treat for me. It's also a soap replacement so he can wash with it and then use it like a moisturiser.

How about starting a poo chart?

You could record when he goes to the loo, whether it is loose, soft, firm or hard and if there was blood when you wiped. Along with a symptom and food diary for the same dates you could then use all the info collected to help put pressure on GP to have further investigations if need be.

Could you slowly introduce protein sources like lentils and beans to his diet and swap out the egg? What protein source do you add to your pasta sauces?

It's actually possible to be constipated and have a daily BM but the food isn't moving as quick as it should through the system.

My DS had this and he started withholding due to the pain, it was awful. We had to stick to a very strict routine for bowels for over a year to cure it. In this time if we missed his time on the toilet even by an hour it would take days to get him back to normal.

We focussed on his diet a lot, lots of berries, fruits etc. We found that certain cereals actually made it worse such as weetabix. I also reduced the amount of dairy he had and gave more beans and pulses and it really helped. We’re a vegetarian household too.

I would say keep on with the movicol, have a look at ERIC and also consider asking your HV for a dietitian referral. And see your GP again if you’re concerned that there’s no improvement.