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3 year old with chronic constipation. Has an open intergluteal cleft from birth. Bleeding rashes after taking Miralax. Advice?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
Have triplets now age 3 born at 29 weeks with a multitude of typical preemie issues. One child has been having extreme difficulty with passing stool...not constipation...dr says he is withholding and he does at times but I also often see him and can feel him bearing down and trying to pass stools that are large, but soft. He had an open intergluteal cleft at birth ( dr referred to it as a "horsetail")which resolved in his 3 month hospital stay but I wonder if this is related as he has never stooled more than once every 4-5 days since birth. At age 3 it is taking over our lives. He is always needing to go and I am able to assist him by holding him in a sitting position with knees pulled up towards chest when he is willing. The problem is interfering with his playtime, sleeptime, crying at all hours that he needs to go. We tried miralax which cause leaking followed by immediate bleeding rashes which made him scared to go and he spent every moment refusing diaper changes and crying how much it was burning so we discontinued. Help.
Posted Fri, 27 Apr 2012 in Child Health
Answered by Dr. Hema Yadav 2 hours later

Thanks for posting your query.

Chronic constipation does itself cause withholding by the child since it can cause pain or discomfort to him.In your child's case there is a possibility of intractable constipation caused by any XXXXXXX defect like tethering of spinal cord or other occult spinal cord dysraphism which can occur in a child with history of intergluteal cleft horsetail. It might cause some difficulty in the normal bowel movement and urinary problems.

I would advise you consult a pediatric surgeon who can thoroughly evaluate and investigate (with MRI scan if necessary) the child for confirming the diagnosis and start appropriate treatment.

If the child has plenty of water and fiber XXXXXXX diet and his stools are not hard then it is not likely a problem of his digestion and gut motility so the usual laxatives won't be of much help.

Therefore a confirmed diagnosis wil help in treating the root cause rather than temporary symptom relief.

So do consult your doctor and discuss the same. If it has already been ruled out then alternative therapies like behaviour therapy might help..

Hope I have answered your query. Please do write back if you have any additional concerns.

Wishing your son a speedy recovery.

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