Can i have an urgent opinion please?? **Trigger Warning - Graphic Images**

[Ouchmyheadhurts]

My dc is under paed care (I have another thread about auto immune) basically he’s had explosive diarrhoea, mucousy stools and stomach ache since January. He’s had two lot of stool samples and all fine? Had bloods and all ok apart from Ana abnormal and low ferritin. He had those bloods re done last week to check. Paed said primal food intolerance, said 4 weeks dairy free, 4 weeks wheat free (currently half way through) and 4 weeks low fructose and ‘see you in a year’

Anyway about 2 weeks ago he starts having blood in his poo/the water. GP not concerned and said probably piles. Today he’s told me he’s being feeling something ‘there’ in his backside, been feeling it a while, didn’t want me to look so I said probably piles don’t worry and if he would feel happy me checking then to let me know. He’s just called me and said it’s happening and let me look. It doesn’t look like piles, I’m petrified it’s some sort of prolapse? He said it happens when he wees, poos and sometimes randomly. I could see whatever it is sort of come out his back side as he was on all fours...... he said when it happened is when the mucous comes out. This is all new to me and I’m really worried. Do I need to take him to gp tonight?? What does a prolapse look like? Could it really be just piles? He isn’t itchy ...

We’ve already done 4 weeks no dart, no change. Now 2.5 weeks into no wheat and no change.

I’m surprised he let her exam him as he wouldn’t at first. So proud of him. She said she could feel a marble size mass and it is prolapse not piles. She said it’s not urgent today and see gp on Monday. So much time wasting!

He has never been constipated so that hasn’t caused it. It’s only today that it’s felt hard.

Take him to A n E.
Blood in poo isn`t good at any age.
Hope he is fine.

You probably know that people with autism have a tendency to bowel problems anyway, and something called a 'leaky gut". I don't know much about it but maybe try googling it and asking on some Facebook support groups?

Yes I am aware of that. Why would he very suddenly develop problems though? I’m concerned he will be fobbed off just ‘because’ he’s autistic.

Sorry to repeat myself but He needs a GP referral to see a colorectal surgeon preferably a paediatric one.

Try to get a telephone appointment or even drop your GP a note, ASAP to get the ball rolling.

Here is a link to a leaflet from Southampton Hospital who have specialist paediatric surgeons

www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Childhealth/Analfissurerectalprolapse-Patientinformation.pdf

I shall be on the phone at 8am tomorrow when they open to try to see someone one. Our gp isn’t there tomorrow but will see whoever we can. Does this still come under gastro? Unless there is an illness that casuals prolapse then I can only assume that the diarrhoea has caused this?

@jobbymcginty how quick do you think they are likely to do anything about this? The person we saw yesterday wasn’t that concerned?

Iv been keeper an eye on his weight since this has happened and he lost a few lbs, he’s just weighed himself and he’s put on 7lbs in 3 weeks......?! That’s quite a lot isn’t it in a small time?! I know it’s summer holidays and he hasn’t been that active but!

I really don't know but the fact he's a child usually moves things along quicker, depends how good your local hospital is as welll

Well we didn’t get any further. Doctors supposedly haven’t had the report from out of hours. She said she needs that to be able to refer back to the paeds. she did agree to doing another stool sample so that’s gone off today. We’ve just had a long chat and by the sounds of it he’s had this prolapse a long time. All year and possibly end of last year. He said he got that before the diarrhoea..... sick of this waiting game.

So.. if he’s had the prolapse a long time why wasn’t this discussed with you who is his parent so that you were aware? Did the GP or pead diagnosis the prolapse?

Honestly if I were you, and if you’re still no further getting some answers I’d escalate to your doctors practice manager and ask for a hospital referral or move GP surgeries. I’d also contact your hospitals PALS as your concerns haven’t been acknowledged.

I only found out a week ago as no one knew. No one had examined him. When he started bleeding they said it will be piles. It was only a week ago when he told me, I said a while back I’d like to check him but he didn’t want me to. I asked him if at any point he felt comfortable please let me know and he showed me last week as it doesn’t always come out. It was diagnosed at the out of hours last weekend. All she said was she could ‘feel a marble shape mass’ as nothing was prolapsing at the time. To be fair to the GP they’ve been ok it’s the hospital that hasn’t. The gp sent a letter to the paed on Monday with news of the prolapse and asked his next steps.... no reply yet. I’m waiting for Monday.....

The long chat I mentioned was between me and dc, not me and he Gp. His stool sample came back all clear. No sign of inflammation still. So what the hell is going on’

I’d push for a colonoscopy that’s the only way that they can see what’s going on inside re the bowl movements. I’d also contact PALS on Monday and perhaps get your GP to refer him to a different hospital as you’re simply getting no where with the current one.

The current hospital is a paediatric one and is amazing. Have been under their care for other things. It’s the paediatrician who I have the problem with.... Iv been awaiting his bloods that were re taken due to the Ana being abnormal. I’m hoping ur are back in Monday, last time it took 3 weeks and they weren’t back in this week so I was waiting for that to come back so I have all the answers before they start saying there’s nothing ‘wrong’. More ammunition if you like... so fed up with it, 9 months now. He thinks he’s had the pro lapse for that length of time.... I don’t know the implications of that but I know it isn’t good....

I still would contact PALS, as even though the ANA blood test may come back positive which indicates a possible autoimmune condition, he’ll then require further blood tests and possibly other diagnostic tests to establish the issue which may cause a further delay to the prolapse being looked at. It’s also worth noting that you can get a ANA false positive result if you have an infection at the time of the blood test, which might be the case in your sons situation as from what you’ve mentioned he’s not got any other symptoms that would indicate an autoimmune condition.

So I’d also be asking PALS why if he’s had the rectal prolapse for 9 months why didn’t the doctor tell you so that you were aware, and given advice on how to manage it if it started causing issues.

Re the rectal prolapse he may need surgery or other treatment to manage it, so regardless of the ANA blood test result your son needs it looking at to check it’s severity and what/if any treatment is required, this will probably involve a colonoscopy. The colonoscopy will also rule out things like colitis and chrons which both can cause diarrhea and blood and mucus in the stool and ultimately can cause a rectal prolapse.

Re the length of time to get any answers, the doctor has had to rule out food intolerances to establish if that is causing the issue with the diarrhea and subsequent rectal prolapse.

If after all of the diagnostic tests and the changes to his diet and no reasons can be found for the diarrhea it will probably be IBS which can be triggered by anxiety, which one mentioned before is common in autism.

Good websites to understand medical conditions and blood tests are.

Patient
patient.info/doctor/rectal-prolapse

Lab tests online
labtestsonline.org.uk/tests/antinuclear-antibody-ana-test

I will be calling Monday to chase for sure.

I know stomach issues do sometimes go hand in hand with autism but I don’t want to just be fobbed off as ‘its His autism’ causing whatever this is. It’s come from no where, never ever had any issues with his health.

As far as paed is concerned he does not have chrons, UC or something else I can’t remember which, due to the results of his bloods and the stool samples.

I’ll have a read of the links thank you.

The pead is incorrect saying that he doesn’t have chrons or colitis after having a blood test!

Crohn’s disease and ulcerative colitis cannot be diagnosed through blood tests. They need further diagnostic tests to rule the conditions out.

www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/diagnosingibd.pdf

Interesting.... in the appointment he said ‘well the good news is he doesn’t have chrons or UC (and whatever the other thing was) as there is no sign of any infection or any problems in his bloods and stools’.

His bloods said ANA abnormal speckled cell staining and low ferritin and smaller than average red blood cells.

The pead can’t rule out IBD (irritable bowl diseases) without further tests.

Re the speckled cell staining ‘The speckled pattern is seen in many conditions and in people who do not have any autoimmune disease’ so further tests will be needed to be needed to establish if he’s got an autoimmune condition.

www.medicinenet.com/antinuclear_antibody/article.htm#anas_are_defined_as_having_patterns_what_does_this_mean

Re the low ferritin levels and small red blood cells.

The ferritin blood test is requested to see how much iron your body has stored for future use. It is the most useful indicator of iron deficiency, as the ferritin stores can be significantly decreased before any fall in serum iron occurs.

Iron deficiency anaemia develops gradually. When your rate of iron loss exceeds the amount of iron you absorb from your diet, the first thing that occurs is that iron stores are used up. In this stage, ferritin will be low, but blood iron levels are usually normal and there is no anaemia. If iron deficiency continues, blood iron levels fall, and red blood cells may start to become small (microcytic) and pale (hypochromic) but an adequate number of red blood cells is initially maintained. With prolonged or severe iron deficiency, anaemia develops.

labtestsonline.org.uk/tests/ferritin-test

Anaemia

labtestsonline.org.uk/conditions/anaemia

Thank you for taking the time to reply blah. What would be your views on if/what could be wrong? Disregarding his autism for now.

Other than the diarrhoea and the prolapse does he have any other symptoms? Does he complain of pain in his abdomen, urgency to go to the toilet, stomach cramps, pain in his joints for example?