5 Year old wakes up on agony with sore bottom

[AmalFish]

Im wondering if anyone can help me. My 5 year old son has had issues with constipation recently and usually poos once every 2 to 3 days (he holds it in normally).

The last two months he wakes up during the night on the days that he has done a poo (usually before bedtime), he wakes up screaming hysterically saying the inside of his bum hurts. He cried and screams for a couple of hours each time. I took him to the GP who said he may have a fissure and to keep giving laxatives till his poo is soft and it can heal but we are not coping with the lack of sleep (not to mention he is not coping at school because he’s so tired!) Is there anything we can do? right now we are just moisturising the bum area but obviously not internally. We use an ice pack when it flares up and give calpol- both don’t seem to do much which is weird as i would think a pain killer should work. He’s totally fine during the day and it never hurts him, only at night and only during the nights when he had done a poo earlier on in the day.
Any advice is super welcome- we are desperate!

I would ring your GP or health visitor, best not to ask on here. I hope he gets well soon, must be so uncomfortable 😢

Assume GP has given lactulose to help with stool softening? Not much you can do as fissures take time to heal. If he's screaming then I would see the GP again.

Have you checked for worms at night? That can cause discomfort

I suspect worms

Assuming you have treated for worms just incase??

My money would be in threadworms!

Ibuprofen might be more useful as an anti inflammatory, if he's in a lot of pain and waking normally in the first 2 hours I'd give both at same time just before bed time on nights he's pooed, so hopefully he wont wake. Id try a heat pack if he still woke not ice. What laxative have they said to use? Something like macrogol hopefully? I've always found lactulose painful to use. I'd also treat whole family for threadworms just in case.

I’d be asking if he may have piles as I would’ve thought a fissure would hurt more often. I agree with treating for worms as well just in case. Also definitely Laxido or movicol rather than lactulose. I’d give ibuprofen before bed on the days you think he’ll wake.

Hemorrhoids in children is another option - although I think you'd probably notice them if you are applying cream.

If it's very painful quite suddenly and not during a BM, no itching or bleeding, I'd suspect it's proctalgia that's probably linked to the constipation. It's worth seeing a GP over because it must be awful to be woken up with a sore butt so often.

Fissures, and haemorrhoids, and proctalgia from constipation, are all treated by softening the poo. I presume he's been given sachets of movicol/laxido/cosmocol (different trade names for the same med). He probably needs somewhere between 1 and 4 sachets a day, and you're aiming for scrambled egg consistency poo. Have a look at www.eric.org.uk

ok so i just managed to look into his bum area while he was screaming and i saw a white thread like thing moving 🤢🤢 so im guessing threadworms ?!! Can’t believe the GP missed that.

Does the entire house needs to be treated? we have 9 month old twins too- will they need treatment?

Thank you everyone for making me consider threadworms

My money was on worms too. Always worst after a poo and at night.
Yes the whole family needs to be treated.
I can't help you with what the options are for 9 month old, sorry.

Threadworms do tend to only be visible at night...

Mebendazole is from 6 months upwards...

I was going to suggest threadworm's too, then saw your update. Glad you've discovered what's going on, hopefully once treated he'll have more settled sleep

Yep i thought threadworms straight away

is the medicine straightforward or does it have side effects? particularly worried about the babies having it as they are under 1.
Thanks everyone for your help. I’m hoping this will encourage him to wash his hands more thoroughly from now on- he often pretends to wash his hands or things it’s funny to skip the hand washing all together.

Have you tried a nice warm bath with some Epsom flakes at night? If it is a fissure like the gp thinks, that should hopefully help with the healing and relief of it.

I would also rule out worms too. They come out at night and if this is when the pain happens then there's a strong possibility that it's them.

Let school know so they can notify parents of an anonymous case in the class like they do with headlice as it's likely not just him with it.
Hopefully reduces the chances of recatching them quickly.

Need to address the problem like the GP said continue with the laxatives until poo soft and he isn’t in pain.
you can’t prioritise sleep when you child is unwell. Help your child first that should be your concern

You can buy threadworm killer from the pharmacy. The whole family must be treated at the same time.

When you treat the family, strip all the bed linen and wash it at 60 C. Cotton and polycotton sheets will be fine at 60 C. Wash all the towels and flannels at 60 C too. You might find it easiest to go to a launderette to deal with this because it's a lot to wash and dry all at once and launderettes have big machines.

Wash all the knickers and boxers at 60 C, or else iron them.

DS needs to wash his hands before he eats and after using the loo. He needs to use soap and a nailbrush. If the soap makes his skin dry or tight, he need to carry hand cream with him, not skip soap.

Yeah thread worms. They're very active at night. You should all be treated and wash all soft furnishings, bedding, soft toys, even sofa covers on at least 60 degree wash as they're contagious as fuck. Preferably 90 if they can take it. Wash hands after toilet and before eating and use a nail brush. A different one each. No sharing towels or anything

OP @selffellatingouroborosofhate & @Balloonhearts have nailed it. Just wanted to add that they are really very common in kids & so ridiculously easy to pass on. Its not that he's super dirty or anything :)

This used to happen to my son when he was young we didn't find movicol that good.We started using symprove probiotic and it stopped after a few months but I would try a treatment for threadworms very contagious at school.

Poor little lad, I hope he’s well soon OP.

Mine had worms back in the day when they were not routinely treated with medication. The GP told me that the worms lay their eggs on the outside at night, so cleaning that area in a bath in the morning will remove the new eggs and disrupt their short lifecycle.

It worked.