Constipation? or Not?

[Twosons]

Ev went almost 48 hours without a bm. Today he's finally started moving again and has had 4 looser but significant bm's but he's also developed an area lower right (where he had thickening) that is very painful. Just returned from the ER. They've diagnosed him with constipation and said to start a stool softener. His on call GI said to watch him overnight and if pain persists to take him to the Children's hospital. The area that hurts he actually flinches and turns white when pressure is applied. I know he is backed up (x-rays verified it) but can that cause a small direct area of pain? I'm so lost on what is normal now. He's never reacted to pain like this but has said as long as no pressure is on the area its just a dull ache. He literally lost color when the ER doc did the exam. He's insisting he just needs rest. I want to relax but I'm afraid of making the wrong call

 

[crohnsinct]

Ugh! So sorry I am of no assistance here. We have lots of constipation experience but not with pain like that. I am so sorry he is feeling so bad and hope that things turn around quickly.

 

[Tesscorm]

It could be that he has a fissure from 'straining' - my understanding is that they can be quite painful.

My son's had some constipation and had a bit of fissure pain (but, not as bad as your son seems to have ). I've given him prune juice (about a 1/4 cup - can probably have more but he didn't like it), yoghurt, and coffee (someone told me this helps to 'go' as well ).

I bought him Tucks and baby wipes to clean - not as rough as regular toilet paper (not sure if he used it though). Also had him dab on some Penaten once he was 'clean'. He also used a sitz bath with epsom salts (only 10-15 minutes, once a day) and he said this did help the fissure.

Good luck!

 

[Twosons]

Thank you both for the replies. The area of pain is to the right of his lower abdominal area. Its roughly a 1" to 2" area which is why I was confused. I'd think with constipation it would be across the whole lower abdominal area. Also, the ER doctor said he was sure it was not his appendix. I've yet to relax since he was diagnosed. I jump at every little thing it seems.

 

[kiny]

Inflammation and fibrosis cause wall thickening (stricturing), it makes people constipated. It's hard to tell which one it is for doctors. Inflammation will subside with anti-inflammatory medication, fibrosis often requires surgery.

Make him drink a lot and make him eat plenty of fibre, when constipation lasts for too long a time, the stool will harden, and you have a chance to rupture the intestinal wall. If it's inflammation, the right medication should bring it down.

 

[Catherine]

My daughter is constipated crohnie. We also use prune juice and increasing doses. Usually start with 1/2 glass, then follow up with another 1/2 glass 12 hours later. We also had an xray to confirm constipation. Don't know about the level of pain. Sarah may problem with constipation was a month prior to dx and she was still in constant pain once the constipation was resolved.

 

[DustyKat]

It is possible for him to have pain in his lower right quadrant since that is where the thickening of the bowel is and the area is inflamed.

Thickening of the bowel causes narrowing and that is why he would be backed up at that point. The constant pressure of faecal matter against an inflamed area of bowel would cause a constant ache and then acute pain when the doctor palpates that area. I would imagine the pain will persist for some time after the blockage is cleared and if the area remains inflamed then the pain, dull ache, will continue.

I hope things settle for your boy and soon! Good luck!

Dusty. xxx

 

[Patricia56]

In case you aren't familiar with intestinal anatomy, the lower right quadrant may be where his ileocecal valve is hanging out. This is the valve that connects the small intestine (specifically the TI or terminal ileum) with the large intestine (specifically the ascending colon).

If his colon is congested with stool and it's backed up into the small bowel then this valve could be stretched causing pain.

Being constipated is not the same as having a blockage. We have a lot of experience with the former and have had many conversations with docs about the difference in terms of symptoms.

A blockage is usually a medical emergency that requires hospitalization where being constipated (or the extreme, called obstipation, where the gut stops moving stool completely) is not.

What we've been told is that a full on blockage will usually cause severe unremitting pain, often accompanied by nausea or vomiting. someone with a complete blockage will be unable to stand fully upright and probably be unable to walk. In other words our docs have said - you will know when it's an actual full blockage.

You can get partial blockages that resolve on their own with bowel rest or reduced inflammation. These are supposed to be less painful.

With my son, constipation is a sign that his CD is flaring badly and the only thing that resolved it was getting his CD under control. The longest he went without a BM was 10 days and that required hospitalized clean out followed by a month of exclusive enteral nutrition to rest the bowel. However, as soon as he started back on solid foods he was constipated again because his CD was still not under control.

hope he is better soon and they are able to get his CD into remission.

 

[my little penguin]

Interesting......
So if CD is actually under control then the kiddo shouldn't be constipated.
Our GI doesnt take DS 's constipation into account for DS's disease activity .
Have to talk to our second opinion doc soon .
Thanks a bunch

 

[Patricia56]

I am only speaking for our personal experience. I do not know if this applies to your child but it is definitely worth asking about when you talk to the 2nd opinion doc. I have heard other parents (a few, not many) say that their children also have constipation as a sign of flare.

I think it is not simple to figure out since many people with CD also have functional bowel issues like IBS which can contribute to constipation and other symptoms like pain. The only way to know for sure is to get your child into remission and see if the constipation resolves.