Persistent 'nappy' rash - intolerance?

[BendydickCuminsnatch]

Long sorry!

DS (2.5) has had a rash around his anus since maybe June or July. I say 'nappy' rash because it's not the skin around his bum cheeks/groin etc, it's literally just an inflamed anus. It's so bad it bleeds sometimes, red raw, and then other times just a bit red. Here's a timeline of the past 6 months ish:

June-ish : DS kept itching his bum so I wormed him (Ovex). The pack says it may cause diarrhoea, but pretty much immediately (next day) he became constipated (screaming in pain trying to pass rock-like poos), so much so I was reluctant to give him the second dose. He has had a hard time pooing ever since (doesn't count as consitpation as he goes most days, but usually very painful for him and a big effort) and has been on Movicol since July-ish. Some times though he has very very loose and mucousy stools (sorry!!)

Around the same time he came back from FIL's house with the worst nappy rash I have ever seen, out of the blue. FIL hadn't changed him all day, we'd already reiterated to him that he had to etc. I could go on, whole other thread. Since then DS only goes for half a day (per week) and sometimes still isn't changed during that time but at least it's not all day.

Rash died down but still remained.

Since then we've obviously been to the GP a few times. We've tried:
thrush cream,
steroid cream,
worming again
and now Timodine (anti-fungal, anti-bacterial and steroid in one, to cover all bases).

I'm starting to wonder if it could be dietary - an intolerance maybe? Probably not lactose, most likely wheat? He loves wheat though surely he'd be put off if it made him feel poorly.

Pharmacist did advise me a few months ago to get him tested for anaemia as I was worried he's so exhausted all the time, but 1) he'd just started nursery so expected him to be tired 2) had a new baby coming so didn't get round to the test 3) he seems less tired these days.

Bathtime now a nightmare as he's scared his bum is going to hurt in the water. Potty training will obviously help air the bum but we have been advised to wait until he's ready, whenever that may be - tried in August but because of the painful poos it was a dead loss, he was scared and I don't want to add psychological aspect to the constipation. He's in size 7 nappies which don't last long, and they're the biggest size I've seen.

Also some nights I notice his lips look bigger and darker than usual but not sure if I'm imagining it.

Have googled many phrases such as 'rash anus intolerance' but it's not getting me anywhere so thought I'd ask in case anyone else's kid has had similar?

Do you use metainum? Whatever the cause that will fix the inflamed skin

I would expect other symptoms if it was an intolerance.
Eczema, tummy pain, bloatedness, general grumpiness , often explosive poo or constipation or a mixture of both.

What do you use in the bath? Presume you are only using some very mild soap and no shampoo etc. Or try Aveeno baby soap or something if not using that type of thing already.
Does he go to a swimming pool each week?
Does he eat a lot of fruit, drink a lot of fruit juice, or tomato based sauces. Wondering is it acidic food that could be a factor?

Thanks for the responses!

Thanks for the responses!

Sorry posted too soon.

Eczema, tummy pain, bloatedness, general grumpiness , often explosive poo or constipation or a mixture of both.
He has constipation and sometimes explosive poos, a patch of excema (only one small patch), maybe tummy pain but doesn't complain of it.

I've tried the yellow metanium and it hasn't cleared it up for good.

Use E45 baby wash stuff in the bath. He does go swimming maybe once every 2 or 3 weeks, but not for the last month or 2 as had the new baby. He does have a lot of fruit!! Because of the constipation and it's one of the only things he'll eat at the mo. By a lot I mean this woudld b typical in a day: blueberries in porridge, half a banana, a fruit smoothie, maybe some grapes. Don't know if that counts as a lot!

You could pay for private allergy testing?

Sorry, forgot about this thread over new year. Today he has pus round his bum! Good grief, whatever next.

We had something similar and finally worked out that it was acidic foods. We cut out citrus (fruit juice, little oranges) and tomato (including things cooked with tinned tomatoes) and it healed.

Try Orabase. You can get it over the counter at some chemists or they can order it for you.
It acts as a barrier and clears up the worst nappy rash really quickly.