Was rectal exam necessary?

[CoconutJellyBean]

My 10 yr old DD has suffered with constipation since she was about 4. She has had movicol on and off all this time. She can have phases of not needing it. A few months ago she had started to be constipated again and had got to about 11 days without having a poo even after 3 sachets every day. So I called the docs to get her a repeat prescription and he asked me to bring her in. We have had several docs over the years just when you are happy with one they seem to leave and you get a new one with no choice in the matter. My daughter had not seen this doc before and I knew she would hate going to see the doc about her problem anyway. I told him this and asked him on the phone what he would be likely to need to do and he told me he would just need to look at her tummy. I told her this and she was happy to go. When we did go he asked all the question you would expect about her diet etc. then started to chat with her about friends and school obviously to make her feel at ease. He then got her to get on the bed and felt her tummy, but then he asked her to turn on her side and pull down her skirt and pants and I asked why he needed to do that and he said to check if there are any anal fissures. She went along with this and I did not stop it but feel I should have interjected and said no that's not necessary, I feel I have let her down because I know that she is still really bothered by it, and dislikes the doctor because of it, she even said today when we were near the doctors surgery, that she hates that doctor because he stuck his finger up her bum (her words) I feel that he was sneaky about the way he did it and I feel terrible that I let it happen. I have been trying to find out whether this is the proper procedure and can't find any conclusive guidelines as some guidance seems to say it is and others say it should be avoided in children because it can be upsetting for them. He also suggested that she should see a paediatrician because it has gone on for so long, but she is so upset when I tell her about the appointments that I end up cancelling and not taking her. I am now in the position where the doctor has stopped the repeat prescription until I take her back. I have been trying to change to a female doc but there are none available. I have tried so many things with her diet over the years and have recently discovered Flaxseed which really seems to help so I am sticking with that for now. But I just can't help feeling I let her down and should gave handled the whole thing differently. Hoping there is a doctor on here who knows if this was right or wrong. Thanks

Oh and some real and IMPORTANT INFORMATION. The,longer your DD is,constipated the more more her bowel will stretch and her colon too. The more time it will take to recover and the higher the risk or permanent irreversible damage.

By that point the rectal exam will feel like nothing as the treatment she will need will be far more invasive.

TBH, you could can sympathise with your daughters dislike as well as making progress with getting her referral.
When I had suspected appendicitis aged 13 and the doc did a rectal exam I went crackers but it was something that at that time was standard practice.

We are much more squeamish about bottoms in this country. In other countries suppositories etc are standard.

I think your GP did the right thing 11 days is a really long time. As well as checking for fissures he was almost certainly wanted to check if there was anything in her rectum or whether she could have a surgical obstruction (which would be an emergency referral). Of course he should have been gentle and explained what was going on, but it is sometimes better just to get on with it, if it has to happen anyway than spend ages discussing it while everyone gets more tense.

I completely understand how you feel OP. You were not given the opportunity to have informed consent before your daughter was examined. The GP was very sneaky and the rectal exam would not provide him with any clues as to your DD's condition. Rectal exams on children should be avoided as they are nearly always inconclusive.

I am appalled at the underhand way this exam was carried out. It's no surprise to me that some people do not trust their doctors. There is no excuse for this sort of behaviour. I was a nurse and had to fully explain the reason for an exam before I would even touch a patient.

I would see a specialist OP, but you do not have to allow your DD to be examined. You may go along for some advice in the first instance and take it from there.

I am very sorry that your DD was treated so poorly by someone, who quite frankly ought to know how invasive and frightening this type if exam is to young children. Shocking.

Good luck OP.

Underhand? The child has problems with her bowels - why would it be a surprise that a doctor would look at her bottom?

I don't know about the specific reasons for wanting to perform the exam on your DD, but I do know that when DH had a rectal exam in A&E he was told exactly why, soecifically asked for his consent and a chaperone was called to be present, even though I was there too. I'd have thought this sort of consent process would be standard in any situation.

A doctor can look at a child's bottom with the parents permission. A doctor cannot touch or digitally exam child's bottom without the parents permission.

Making a big deal of this- 'underhand', 'duped' is what will damage your daughter, not getting appropriate treatment.
Please put your concerns to one side, reassure her and chase up the referral.

Whilst I agree with what most are saying on here, I do think some of the responses have been overly harsh and typically MN self righteous and critical. It must have been hard to see your dd distressed and having to undergo a procedure that is intimate but probably necessary (although that seems to be up for debate) for that doctor to assess the patient. That particular doc hadn't seen her before so perhaps the rectal exam was what he would ordinarily do for his particular assessment. As for not mentioning it on the phone, he maybe hadn't considered it until her heard more of her history in person.

I do agree that you maybe have to take the bull by the horns and get her to see a specialist paed who can get to (excuse the pun) bottom of this. It maybe hard for your Dd at first but hopefully it will be worth it in the end. Sounds like she was a lot more relaxed with the female doc. And let's not forget folks, she's 10 and Prob starting to or already very aware of her body and changes and being overly shy and sensitive.

Good luck OP and your DD

Some of the responses have been fucking horrible. Why do some of you think it is ok to be so awful? Do you think it will help the situation? Because I don't. I think it will make it worse.

Shame.

Agree with other posters don't think gp done anything wrong tbh. My youngest dc had constipation when he was younger. 18 days was the longest he went without having his bowels open. He also had a rectal examination at the gps He didn't like it much but I calmly explained that the why the doctor did it and I stayed with him at the time. He doesn't even remember it now.

You were not given the opportunity to have informed consent before your daughter was examined.

This.

Doctors have a responsibility to obtain informed consent from parents and, just as importantly, from the children in manner that is appropriate to their level of understanding.

It doesn't matter whether this examination was necessary; it shouldn't have happened without the consent of you and your DD.

OP, you need to contact the paediatrician, explain what happened and ask for their help in reassuring your DD enough to get her to an appointment.

Then consider making a complaint to the practice manager to help prevent this from happening to any other children.

Coconut I have just seen this thread. Even though it is a Zombie thread I would like you to know that I entirely sympathise with you. I think it was horrible for your daughter and you.

I do not think the doctor realised how invasive he was being but rather just assumed that was what he should do. But that does not make it all right. If that is how doctors act routinely then that is wrong.

You asked before hand what he would need to do - he did not mention this. It is not surprising you felt no control and that you feel you let your daughter down. No one has the right to put their finger in her bottom without her prior understanding and consent - doctor or not.

Having said that I think one reason for feeling with a finger would be in case there was a growth of some kind causing a block, though that might be investigated only after other approaches had failed.

I hope you found a female doctor.

I hope you get to the bottom of the constipation.
Have you tried having her drink a glass of water before going to bed? Then a glass of warm water with a little lemon juice every morning. At least four more glasses during the day. A tablespoon full of ground flaxseed mixed with plain live yogurt
and berries. Leafy vegetables on half the plate for lunch and dinner. Sweet potato.