Question: 5 years old girl: May 14, 2006
Weight 57 pounds, 100th percentile on height and weight. Tallest in class.
Problem: Frequent Burning when urinates, red rash on anus raw ring, vagina very red, painful and skin around labia, cries about it hurting daily. Occasionally itches.
Direct Correlation: to what she eats, fruit, pizza sauce, citric acid     
Pain level: mild to very severe, worse at night when tired, the redder the more pain

History:
Bad diaper rash until cut out fruit and juice. That’s why potty trained as early as possible. Used sensitive wipes and diaper rash cream.
2 years old: Couldn’t pee because burns so bad.
1 Fever, no symptoms, tested for infection, white blood cells high, Culture shows no infection.
Burning when urination continues off and on for 3 years. Quit asking Dr. because never a urinary infection. Just dealt with pain, give lots to drink to clear out system.
Mom withholds fruit and citric acid drinks and foods. Seems to help as long as diet is from home. Daycare worked pretty good. Tells teacher no icee pops, no juicys, no fruit, no sprite,
Mom gives high fiber breads, noodles, baked beans, chips with fiber, waffles with fiber, ect…. But still has constipation because no fruit.
Occassionally tries a bite of bannana or a small applesauce, usually sees burning start within an hour or two. She deals with the pain so frequently that she may not always tell me. She makes it all day at school, and usually tells me at night if it does. She tells me all the time, “Momma I’m burning.”
She knows what she can and can’t have at school. Read school lunch menus to plan if need to send lunch if menu is tomato based. Burning connected to peanut butter & jelly lunch alternative.
I want a Dr. to tell me for sure.
To deal with pain I’ve tried Tylenol because she can’t have Ibuprophen. Try zyrtec to help if allergy related. Recently realize these have citric acid in it and may have contributed to continuing the problem.      
Can’t have NSAID anti-inflammatory medicine because she has a genetic disorder she tested positive for HHT Hereditary Hemorrhagic Telangiectasia ( WWW.WWWW.WW HHT is a genetic disorder that causes abnormalities of blood vessels. Most blood vessels in the body of someone with HHT are normal. However, a small percentage of the blood vessels in a person with HHT have a specific type of abnormality.
Doctor visits:     
Family Doctor 2x: Urinalysis- WBC high, trace blood, no infection when cultured
Pediatrician: No solution from Pediatrician other than control constipation with Benefiber and Metamucil (stool softener). Bottom hurts when stools are large or too hard.
5 years old. Went for 5 year check up. Burning was current. White cells high, no infection when cultured.
CBC                     Range
Lymphocytes 53.6%          H 40-45
Urinalysis in house
WBC           5-7          0-4
Bacteria     trace
Blood          trace-intacted
Referrals starting:     
Urologist- referral in January
Pediatric gastrointential- stated was not a urologist, treated for constipation, clean out with Milk of Magnesia then continue on daily capful of MiraLax. Stomach x-ray- stretched colon, scattered poop, lot for using miralax almost everyday.
Allergist: tested blood, not high for pollen and foods we tested, but IgE is 88 with range 0-80, could be a combination of things, nasal passages definitely indicated allergies. Wants to get tonsils out, very large, help with allergies.
Radiologist: VCUG x-ray normal, stomach ultrasound
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Stool softener: I stir about ½ capful in her tea every other day. Sometime more if we need to clean her out. This summer I didn’t have to use any very often. We started this back at Thanksgiving last year.
Family Dr. said increase to a capful everyday. This year.
•     She always has a bowel movement every night. We start this only when she skips a night, starts burning, or stool is hard or large to prevent pain.
When burning was severe and nothing seems to help we make sure we are taking all these steps:
•     Changed shampoo to XXXXXXX with no citric acid in it. (only the blue bottle)
•     Use sensitive toilet paper. (could be school toilet paper) Once sent our own tp to daycare.
•     Give baking soda baths.
•     Wash underwear in sensitive detergent
•     Drink extra water, tea or milk (send water bottle to school)
•     Cut out sweets

Why does it burn? How can we stop it from burning?