dreadful bleeding nappy rash and stool witholding - heartbreaking :(

[humbergirl]

Hello, firstly, sorry for the huge post, i'm desperate for advice....
Here goes....

My 2 1/2 year old little boy has been witholding his poos for about 3 months now, we thought it was a phase, tried all the recommended methods from ignoring to explaining, books, etc.. but after many GP visits theres no improvement and he has the most horrendous bleeding, weeping rash on his poor bottom, its heartbreaking, latest visit was 2 days ago and we were given metonium, which has done nothing except maybe aggrivate, have been advised today by HV to apply sudocrem then vasolene, sadly as the rash is so weepy the creams don't hold. There are two problems here, the witholding and the rash, currently the rash is the most important problem in need of treating because he is suffering SO much, but it seems one can't be cured without the other.... and we have tried everything from fungal creams to pure aloe, to bicarb baths (not all at the same time each has had several days to see signs of improvement but nothing...) he's crossing his legs 'keeping it in' many, many times a day, each time a tiny bit of what the doctors call 'seepage' (sorry tmi, watery poop) comes out which needs wiping and here is the problem, its a vicious circle.

We've tried all the recommended books and methods, I just want someone to come along and say 'here's the cream, try this method' and something work and ease his pain, because nothing has so far, and being the bad guy and having to constantly bath, bathe wipe and apply, I feel wretched and spent most of today in tears (without him seeing). My son is potty trained for wee's and we spend as much time as possible with nappy off, but when he has a leg crossing holding in episode, bits leak out which we have been choosing to bath (up to 5 times a day) instead of wipe, as the wiping takes off the top layer of the rash and it bleeds.... we've been told we are doing and trying all the right things and that 'it won't be forever' but he's 2 1/2, he's in a lot of pain and he doesn't understand any of this, he is hurting so much. Has anyone been through this?

Thanks for reading.

Best thing ever for horrific weeping mess is "Sprilon" Spray, general use is for protecting bedsores.

We got it on prescription but you can buy it althought they may have to order it in. About £8 per can but does last for many many months IME.

2 advantages, you spray on very thinly so it still "airs" the wound, plus you spray so once you've cleaned you don't have to touch the wounds again.

I tried everything before this and it was the only thing that made a significant difference. Remember lots of fluids to drink as well as whatever laxatives you use.

Your poor boy. My ds was constipated when he was about 2 years old, he'd withhold as it hurt to try to go, he was in a right state. I got movical from the docs and I think I used the junior califig too (I can't really remember as it was 5 years ago) but it's important to use something that will soften it up so it won't hurt and he cannot hold it. He has a hard stool up there which needs to come out.
Wrt the nappy rash, that sounds awful for him, and for you. Could it be a fungal infection? One of my dds has this and no nappy rash cream would get rid of it she had oral drops to clear it. But maybe try canesten to see if it will make a difference? Does it look infected?
Tbh I wouldn't put vaseline on an open weeping sore that I wanted to dry out, or even sudocreme I would only use these on closed skin to create a barrier to stop nappy rash getting worse.
Try the egg white suggestion or the spray to get it dried out, and hopefully one the seepage problem is gone, the nappy rash can get a lot better. How he is ok.

Sorry I've just realised you've tried fungal creams already.

Hi there OP, you've had lots of v good advice already. IME there is no one correct answer here. Unfortunately it's trial & error to see hear works for your son. I'm a nurse & have dealt with lots of wounds & depending where they are they can lead to rashes like you describe. You are right in assuming the damp skin leads to the rash. So you do need to dry it out: v diff obv. If you could apply something which would absorb the ooze/faeces without soaking the skin it'd give the skin a break. We use a dressing called AQUACEL. It's an alginate based square which would adhere to the area a little. It's probably need replaced regularly & is expensive. Really think it would help. I'm sure at this stage there's a fungal element to the rash. Persevering with alternating Clotrimazole with Hydrocortisone, Metamium mixed with Sudocreme (a trick from ICU) & AQUACEL dressing you might get on top of things. But you MUST persevere with the Movicol. What he's suffering from is called 'overflow'. Liquid poo from the higher up part of his colon is leaking past the blockage of very hard poo. It won't stop till the blockage is gone & the blockage needs broken down before it can pass. If it's too big hard then it could cause a fissure internally, which causes pain for him to have a bowel motion & perpetuates the withholding. I'd hazard a guess he already has this & resign myself to using the Movicol for the next year or two. If the poo never gets hard enough, the fissure will heal & that skin gets stronger & less likely to break again. I'm speaking from personal experience with my 6yo...nowhere near as bad as your poor son, but awful experience & I really feel for you both. It's so upsetting for you both & it sounds like you're doing an amazing job. You're a fab mummy & you will get there.

Plse excuse all the spelling mistakes. I'm on my phone with a baby snoozing on my chest, typing L handed! Multitasking ;-)

You mentioned you're using wipes to clean his bottom. It's probably unrelated but DS got horrific nappy rash when we switched to huggies wipes because it turned out he was allergic to them. The rash never healed because it was being made worse every time we wiped, and it caused awful weaping blisters. It took us ages to realise the link but cleared up quickly when we went back to pampers sensitive. When he had the rash he also started withholding because it was so painful to poo, I think.

Hope you find something to relieve it for him, poor little thing.

I just wanted to share a couple of tips re the nappy rash. My DD had major gut problems when younger and this is what her surgeon and nurses at GOSH recommended for nappy rash. No Metanium! Try to get some Ilex on prescription. It's a paste that will form a hard layer over the skin to allow the skin to heal. It's amazing stuff. Then use cotton wool aqueous cream to wipe poo up (the Ilex will stay in place). Ilex can be removed after 24 hrs or so with olive oil and cotton wool to check how the skin is healing underneath, then reapplied if necessary. Or if skin better move on to a cream called Medihoney (again will need prescription).
I hope that helps.

Re my post above - check with your doc about how to remove the Ilex - it's been a while and I might be wrong re the olive oil. Good luck.

If you aren't keen on the egg white idea, there is a medical version. Cavalon make a stick, the end is a soft sponge like material and it is soaked in the sealing liquid. You paint it on and let it dry and it stops any wee/poo coming into contact with the rash.

We had to use it when dd was very ill and had constant diarrhoea. It doesn't sting at all and cleared it up in no time. It also lasts very well.

The egg white should do the same job though.

From a bit of googling it appears that Ilex may not be available on NHS prescription. But you can buy it online.

Netmums discussion link

Website for ordering Ilex

You need more Movicol. It doesn't sound as if he ever got unimpacted if you were having frequent sticky stools. You should have been advised to up the Movicol until you have stool the consistency of gravy and he was totally unable to withhold it. And then slowly cut down until you were having stools every day easily with no withholding - and then stick on that dose of Movicol for months and months.

The ERIC site is brilliant but I can't see the point in 'watching and waiting' at this point as clearly nothing is changing or being sorted. I'd push for a referral to paediatrics incessantly- this is bread and butter stuff for them.

One more thing (sorry!). If you do get hold of Ilex, you need to add a layer of Vaseline on top of it to stop your son's nappy or pants sticking to it.

Ex Chef here.

The egg thing we used in the kitchen for burns for years and it really is amazing.

Break and egg into your hands - drip the white into a bowl and bin the yoke.

Whisk the egg white with your hand and then coat on any type of burn - which is effect what nappy rash is. let it air dry, recoat as necessary. this HONESTLY works on all burns ever nasty ones. Obviously do not use if there is an allegry to eggs. But I would really give it a try.

You should see an improvement in about 24 hours.

On the other issues I have no advice at all Im afraid but I just wanted to say that you are amazing and doing the best you can and you sound like a wonderful mum.

Dont let the medical profession fob you off, you know your baby best and keep pushing for a referal if that is what you think your baby needs. You are the expert on your child, dont let them tell you otherwise.

Are you using pampers? My son had awful nappy rash when I used pampers, after I changed brand the rash went away and he never had it again.

Thanks so much everyone, and everything crossed we get somewhere soon x

Oops sorry I didn't see half of these messages as I've been working this weekend and only just back online, and I didn't refresh, some amazing advice here, I will keep you posted on our progress, I've ordered some cavilon spray, and I have some dermal 500 for when I need to wipe with cotton wool, and perhaps start him on the movicol again. Such a wealth of knowledge here compared to what I've been offered at the doctors! Hugely appreciated too x

Sorry for my apparent total lack of punctuation!!

Oh and yes, pampers, but trying to avoid nappies except for at nighttime, and not using wipes, stopped them first and used cotton wool pads though am considering some kind of cotton cloths? Trying to bathe rather than wipe due to the little blisters, they weep when contact is made with them.. Poor baby, he's still so chipper, considering what he's going through.

Are they the pampers in the orange pack by any chance?

To start, yes, then we changed to the purple ones

Hi, I haven't read all the replies as I'm at work, we had this with dd now 7.
Honestly the only thing that worked for us was Bepanthen, she had the most horrendous sore bottom from withholding. I cleaned her with the bepanthen too, covered her bum in it and used cotton wool. Then slathered her in it till the next time. I also let her stay bared bottomed while at home, also she found it harder to withhold while naked.
It is heartbreaking to see them in pain. I would give him calpol/brufen while it is extremely sore too. We ended up on movicol for a long time, and as she has gotten older she understand she has to go. I hope it resolves itself soon for you.

It was the orange pampers that caused DS1's nappy rash, I can only liken it to a "chemical burn" , it was truly awful. I also know of another child that had the same reaction. I changed to Huggies at the time and I saw the change within a few days. I really hope you find a quick solution and your little one is on the mend soon.

I'm wincing just reading it the state of his bum Have they swabbed??? DD4 had strep A which gave her horrific nappy rash. Does he have any peeling skin at all? She also had little blistery spots - can't remember what caused them.

I was fobbed off for over a year until the detected the Strep A

My ds used to get bad nappy rash at any pampers. We've found Asda Little Angels and Sainsbury own brand better for his bottom, and less leaks too.

Thanks again for everyone's help, I took my son back to the doctors today as a new row of blisters appeared last night, and he's getting very upset, he says 'mummy it's hurty' about every 15 minutes and wants a cuddle, it's heartbreaking and frustrating not seeing an end in sight for him, we were given a script for loads of aqueous cream and advised to up the movicol until he is completely cleared out. I asked for a referral and was advised this was the advice a paediatrician would give... So far no swabs but I spoke with the health visitors last week and they booked us in for next week (2 week wait!) and she said if it's still sore she will swab it. We're into our 5th month of withholding now.... I wanted a referral for help with the psychological element to it, from someone who is well versed with this problem with toddlers, seemingly it's common so it would've been nice to have the help of someone from a psychological side rather than just using movicol for a purge.... I just want to do the right thing by my boy and see him as happy and worry-free as he should be at his age.