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.

Check what’s in the multi vitamin - iron can cause constipation and hard stools. Fresh orange juice in water can help soften stools as well.

Bananna, apples and egg can all cause constipation. I would try switching to prunes, dried apricots, oranges. Increase fluids, I know fruit juice isn't great for kids but a glass of fresh oj every day should help.

With that diet I would

A. Ditch the banana.
B. Replace the glass of milk with fruit juice
C. Add dried fruit to the cereal (prunes ideal)

D. Add some veg sticks and ‘wet’ fruit to his lunch.

E. Give him more variety at dinner time. Purée some more dried fruit and put it in natural yogurt for pudding.

Don’t overdo the dairy.

And keep going with movicol. Speak to GP about anaesthetic cream.

I would stop the bananas, and add a ripe pear, orange, strawberries. Orange juice and popcorn can also help..

I find that stopping drinking milk/ eating yoghurt helps. And then prunes, orange juice, fibre one bars and raspberries are best!

I'm afraid I agree with other posters re banana. The ONLY time my child ever had constipation was after eating her first banana. She screamed in pain for 2 days. We didn't give her banana again for over a year and now she can eat them with no problem. She is thriving on a plant based diet but eats beans/chickpeas every day along with fruit/veg/carbs. Does your child eat legumes? If you cut out banana and there's no change within a couple of weeks I'd investigate intolerances to dairy or wheat..

Hello!

I'm a lifelong member of the constipation club and I have an anal fissure which reopens from time to time, the specialist who examined me said it was like a scar or something, weakened and easily reruptured.

I have an elongated bowel, so it takes much longer for food to reach its destination, which tends to make it too hard.

My eldest DC has also had the same issues since birth.

OP the daily diet you posted has too much dairy and too many carbs. They're my favourites so I know from personal experimentation (as well as testing things out on my DC) that too much dairy, bread, pasta, rice, crisps and bananas (I don't like them mushy, ugh) will cause really bad blockages.

Movicol two times a day, plus occasionally three times, is what my DC had to have, for years.

It does get better. There are side effects from movicol, but over time the problem clears and any fissures will heal.

I would do what a PP suggested and see your GP, mention the surgery, say that you'd like to try movicol first at a medium to strong dose to begin with, before resorting to surgery.

And please do change that diet. It sounds good but it isn't. More carrot and cucumber sticks, and grapes, these are how I get the DC to improve their diet when we've been a bit lax.

Homemade lentil and veg soup (onion, carrot, cabbage, cauliflower, red lentils, chicken stock, blend till smooth - ish. Could add half tin chickpeas also)

Homemade apple sauce (apples, peeled and cored, reduced down eiht à splash of water)

Dates

Lots of water

Best to stay away from citrus fruits with a fissure - so no orange juice until healed (although it does help with constipation). Similarly chocolate and caffeine, including cola and tea should be avoided although I assume he isn’t consuming them at his age.

I agree that his diet is a bit dry - give him more fluid and ditch the egg in favour of beans, lentils and other pulses.

ERIC is the children’s bowel and bladder charity.

Eric.org.uk

0808 169 9949

Yeah, bananas are bad for constipation, so I'd stop that. Also get wholemeal biscuits etc, cut out the white flour entirely, and make sure he's drinking lots.

Thanks all. I will take him back to the GP today. I read all your responses and I’m very grateful for your inputs. Made a list of changes to try.
To make it worse, last night he started to say peeing hurts. I feel like crying. He had a UTI just last month :(

Chronic constipation can increase the risk of UTI in boys.

A lot of responses used the word “constipation”. Is DS considered constipated even though he poops every day? Sometimes twice a day. Its just very hard in consistency.

Also, someone asked if it was always like this. No. As a baby he had soft poos. The problem started around 6-7 months ago and I can’t figure out what changed.

Does lactose intolerance cause hard poops? I ask because he was diagnosed with mild lactose intolerance when he was around 1yr old. We switched to normal milk and after a few weeks he began waking up crying screaming at around 10-11pm every night and passing gas. After a lot of GP visits and breaking our heads worrying about it, one angel GP (bless her) advised us to try lactose free milk. It changed everything for him!
Last year we slowly re-introduced dairy back into diet again. No night time screaming and gas. So I thought he is no longer lactose intolerant!

Hard lumps/pellets seem to be the number one indicator of constipation. Despite going every day perhaps he's only passing a small amount of what is in his bowel.

I get constipation from anything bready, including pizza, and from eating ripe plums or potato with skin on. My body can't seem to digest these properly but as long as I don't eat them I don't get constipation. I'm sure everyone has their own set of foods that cause it, but there must be some other common ones (like banana). Definitely try keeping a food diary and vary what ge has each day so that you can spot when it gets better/worse. If he alwaya has the same foods each day you win't be able to unpick the culprits. Start with eliminating banana though.

poophacks.com/bristol-stool-chart/

a lot of responses used the word “constipation”. Is DS considered constipated even though he poops every day? Sometimes twice a day. Its just very hard in consistency

You can be constipated but still have a BM every day.
Also carry on with the ripe bananas but make sure they’re very ripe I.e lots of big brown spots. Those saying that bananas are bad for digestion are thinking of unripe or just ripe bananas (I’m a HCP)

A lot of responses used the word “constipation”. Is DS considered constipated even though he poops every day? Sometimes twice a day. Its just very hard in consistency.

Oh god yes. Passing small amounts of hard stool 1-2 times a day absolutely means he’s constipated.

Imagine his gut being really backed up with poo. The longer it stays in, the harder it gets. Each day he manages to pass a small amount, but the backlog (no pun intended) remains. That’s still constipation.

Have a read of this website which is excellent: www.thepoonurses.uk/

“Macrogol laxative” is the same as Movicol, which is the brand name. It really explains how to use it. I think your son probably needs to do to disimpaction regime first, to clear out the bowel. Then, once clear, you remain on the maintenance regime, making sure his poo is runny and he’s going at least once a day.

I feel so stupid assuming he is not constipated because he goes everyday :(

I’m seeing the GP later today. I stopped bananas for now. He had apple porridge for breakfast today. A pack of raisins and juice mid morning.

Hi OP,
It is not so much as the healing time which I would be concerned about but the texture of his poo.

Fissures take a lot longer to heal than people expect. Because the skin is so thin and delicate and it is being stretched so often. I had them after DS1 was born and they took abut a year to fully clear up. Plus, you can have really soft stools for a month and just one harder one and you are back to square 1.

It is good that he isn't in pain so he is not tempted to withhold as that can make it far worse, but speak to your doctor about how his poo is often hard and dry as there may be a food intolerance factor or something more effective she can recommend.

I found shots of prune juice worked well and perversere with the Movocol.

He eats a lot of rice. Could you change to a brown rice which would have more fibre in it? I think you should be offering more drinks as well, if he doesn't drink much then try homemade ice lollies instead.

We upped his drinks today. He is on his second cup already. I bought some prunes. Will purée them for him.

I'd also have a look at coeliac disease.

A lot of responses used the word “constipation”. Is DS considered constipated even though he poops every day? Sometimes twice a day. Its just very hard in consistency.

I agree that this sounds like a blockage further up. Definitely speak to the GP as they may give a really big dose of laxative to clear out the blockage rather than just softening things.