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Constipated. Started getting perianal pain and itching. Looking for proper diagnosis

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Practicing since : 2000
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Hi. This is a little XXXXXX. My 8 year old daughter has been complaining off and on (about 3 weeks or so) of pain when moving her bowels or just after she's moved her bowels. She has an urge to want to sit on the toilet. Sometimes this is accompanied by her saying her "bottom hurts or is itchy". Mind you, this is not every day or night. This can happen maybe once a week or twice a week in the last month or so. I believe this is due to constipation and I did get her some stool softener to help move things along and the last two nights she has not complained of anything hurting her or itching. She moved her bowels 3 times two nights ago and yesterday, nothing. Of course, because I'm always freaked out about anything disgusting, I checked her last night in the middle of the night while she was sleeping for pinworms. I moved her buttocks cheeks and using a flashlight tried to see if there was anything there -- and thankfully, there was not. She does tend to have itchy skin and I have to use a special moisturizer on her much of the time. I'm wondering if the bowels had been hard and when she was moving her bowels, or after her bowels, for some reason it felt painful, or "stinging or itchy". A couple of times it was unbearable for her. A pediatrician checked her yesterday and didn't see any redness around there. Do you have any thoughts?
Posted Thu, 18 Apr 2013 in Constipation
Answered by Dr. Poorna Chandra K.S 16 minutes later
Hi and thanks for contacting XXXXXXX
Perianal pain and itching associated with constipation is usually because of a fissure in ano. The fissure causes mucus secretion which inturn causes stickyness and maceration.
Keeping the stools soft will help heal the fissure and improve the symptoms. Hence continue with stool softners and watch for atleast 2 weeks. If still persistent then see a proctalogist
Above answer was peer-reviewed by
Follow-up: Constipated. Started getting perianal pain and itching. Looking for proper diagnosis 15 minutes later
Thank you for responding. I appreciate it. Since I am by nature, an extremely nervous person, aside from doing what I've been doing (giving her stool softener and monitoring her each day), should I still be looking at her in the middle of the night for pinworms? As I say, I went there at 3:30 in the morning with a flashlight and did not see anything -- and as I understand, it they are visible to the eye. So, am I supposed to keep doing that for a night or two or is one time enough? As I mentioned, the last time, she doesn't experience the "painful or itchy bottom" episode every night. Sometimes it will be twice a week, other times nothing - I still believe it's somehow related to the constipation or painful bowels but being a nervous, anxious person I want to absolutely rule out anything disgusting like pinworms. The other night the pain was bad enough I made her a bath in warm water which she loved. But as soon as she got out, she complained that her bottom itched her again.
Answered by Dr. Poorna Chandra K.S 45 hours later
I understand your anxiety and pinworms can cause itchy bottoms. A easier way would be to give two doses of tab albendazole 400mg seperated by a weeks interval. Deworming should be for the entire family to be effective and it is a good idea to do it once in 6 months.
Fissure can cause intermitent symptoms and sitting in warm water soothens it - and this is the basis of sitz bath given in fissure
Keep the stools soft and do the sitz bath twice a day
Above answer was peer-reviewed by
Follow-up: Constipated. Started getting perianal pain and itching. Looking for proper diagnosis 11 minutes later
Thank you, Dr. XXXXXXX I actually had to take her to the ER two nights ago because the pain for her was so bad. The doctors looked at her bottom and saw the fissure that you diagnosed. Then they took an X XXXXXXX of her abdomen and saw it was completely compacted. So, obviously what must have happened was that she had been so constipated and at some point recently, she must have hurt herself trying to move her bowels which caused the fissure. So now I must place her on MiraLax for 30 days and make her eat only fiber foods (fruits, vegetables and no white bread). And of course, much more water. The sensation she was experiencing in her bottom was itchy, stinging, and she felt as if someone was cutting her there -- and it was always associated once she tried to move her bowels and after she moved her bowels. Anyway, I just wanted you to know that the ER doctors confirmed your initial diagnosis. Many thanks,
Answered by Dr. Poorna Chandra K.S 26 hours later
Hi and thanks for writing
Please continue all that you have written and your daughter should be fine. Get a thyroid function test also as it is a common cause of constipation
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