Need Help with 5 year old who's Afraid to Potty - Blood with BM

[Jennifer]

First off I want to say that this is for my niece and she has not been diagnosed with any form of IBD. Her Ped isn't concerned that it is and feels that she's just holding it.

She has a bowel movement about every 4-5 days. When she does go it's hard and has some bright red blood (not a lot but maybe 10-12 drops or so on one occasion from what I was told and sometimes less). She has blood with every bowel movement but I'm not sure how long this has been happening. She's afraid to go to the bathroom because it hurts. She holds her urine in as well for the same reason and has gotten UTIs.

She seems to be regressing with potty training (she's turning 6 this Oct.) to where she only wants to use the little trainer potty they still have at home and refuses to use any other toilet (not even the small kid ones at school). Her mom is concerned that this behavior may be stress related but I'm not sure. Her Grandma on her dad's side passed away last year and he didn't handle it well so has been distant from the family.

She's an EXTREMELY picky eater. She will eat chicken nuggets, applesauce, Top Ramen (prepackaged ramem noodles), rice, flavored seaweed strips, cheez-its or goldfish crackers and chips (usually Doritos). She will drink milk (her mom has started cutting it with water), ice (well chews it, tiny ice cubes they call "baby ice"), and popsicles.

Her Ped is having them try a stool softener for a week (it's been a week and she's only gone once, it's been almost 5 days now since she's had a bowel movement) and then, I don't know what the plan is. Her mom has fiber powder that she puts in her drink and is limiting her sitting time and encouraging exercise (she likes to watch videos on the ipad) and is trying to increase her drinking with the ice chips and popsicles. Her mom also uses vaseline on her bottom before she has a bowel movement.

Both her mom and dad have broken down and pleaded with her to just try to go and have explained with diagrams of what happens when you don't but she still won't go.

Does anyone have any suggestions on how to get her to go more regularly or how to make the BMs less painful in the meantime until she becomes more regular? Any suggestions at all are appreciated.

 

[CrohnsKidMom]

Do they know for sure she is holding it, or is she constipated? Of course, holding it can result in constipation, I realize. Careful observation might reveal which it is. i would want to know the reason for the blood. If it is due to hard stools causing some tearing, or something more serious. There does seem to be very little fiber, and nutrition, and maybe water, in her diet. I know many kids (my own included) here use Miralax/Restoralax to soften stools, on a ongoing basis. But I would want to discuss that with her doctor before using. Good luck!

 

[Jennifer]

I'm not sure how she was examined to be sure that it was from tearing. As for if she was constipated first or if her holding it resulted in constipation, I'm not sure of that either. From what I understand is that this has been going on for quite some time but the blood is more recent. I'm waiting for my sister to reply then I can get back to you. I'll also have her talk to her Ped about trying Miralax/Restoralax. It doesn't sound like a stool softener is enough at this point.

 

[Mr chicken]

I know for DS constipation was a big issue around that age .
He still has constipation as part of his crohns

Did they do an xray to see if she is backed up ?
Then do a clean out with miralax daily afterwards to maintain pudding soft stool .

Sometimes fiber makes things worse at least it did for my kiddo

 

[Farmwife]

Yup, fiber makes it worse for Grace.
It takes a good week on stool softens to start moving.
I agree that the blood droplets sound like what Grace now suffers with, fissures.

If she is holding it, it could because she's afraid of pain when passing.
Don't assume that she would tell mom and dad about the pain.
Grace and kids her age trends to want to be self sufficient and stubborn as all get out.:yfrown: and don't tell mom their in pain.

I think the stool softeners will be a help one they work.
The food aversion sound familiar to Grace.

Don't you have a sibling with ibd or am I thinking of someone else?

 

[Jennifer]

Yes one of my sisters also has Crohn's but not my niece's mother. I'm always concerned about that possibility though.

Her mom said that my niece told her that it's too painful to go. With pain and blood loss, I would prefer a doctor who was more proactive especially with multiple family members with a form of IBD (our grandma on our mother's side also has microscopic colitis). While diarrhea is common with Crohn's, there are many who suffer from constipation.

 

[crohnsinct]

^tru dat! My younger one presented with constipation as do many of the kids here. Not saying she has IBD but with a family history some testing should be done to rule it out. We treated my younger daughter's "chronic constipation" for three years before they finally took us seriously and tested for Crohns.

At a minimum, I would want to see a fecal calprotectin test run...simple non invasive and full of information.

All this said, my older daughter was encopretic. All the way up to 7th grade. It was a hard journey. Diet, exercise and FLUIDS are key. True what everyone says about fiber. You can't increase the fiber without at least doubling the fluids or it will cause more issues. Plus I would want to rule out IBD before adding more fiber to her diet. We did Miralax and senna with my oldest for over a year before we slowly brought her back to more solid BM's. Long hard journey.

You are a good sister and aunt!

 

[Farmwife]

The food aversion thing.......
Does your niece say if certain foods hurt her belly?
Also if she hurts going poo she might associated with certain foods.
Grace for the longest time avoided strawberries because after eating a slice she had a painful poo.
I told her it wasn't the strawberry but she still avoided it forever.
Kids are so hard to read sometimes.

 

[kimmidwife]

We had a lot of BM issues with my youngest. We ended up putting her on a daily dose of miralax which helped a lot. Once she starts on the miralax I would also tell them to avoid making a fuss over the issue. What they can do is put up a sticker chart on the back of the bathroom door and allow her to get a sticker whenever she poops. After a certain amount of stickers I would allow her to get a small prize. I would also tell them to put some fun picture books in the bathroom that she can look at while she is going.

 

[Jennifer]

Not saying she has IBD but with a family history some testing should be done to rule it out.

At a minimum, I would want to see a fecal calprotectin test run...simple non invasive and full of information.

I agree that it's a good idea to rule it out. I'll mention the stool test to my sister and see if she will be interested in asking her daughter's Ped to do it.

I haven't heard how the appointment today went yet.

The food aversion thing.......
Does your niece say if certain foods hurt her belly?

I'm not sure. I'll ask. I know she doesn't eat cake or ice cream for some reason (that always baffled me). She also stopped eating peanut butter and pizza but I don't know why. She does like cookies but as far as I'm aware, she's never really been too adventurous with her food choices. I always assumed that had to do with what her parents and older sister chose to eat.

Thanks kimmidwife. I'll suggest those.

 

[CJMom]

Sounds like it may be encopresis. My child had that around that age. That is holding of BM's, which then leads to constipation. Try daily mirilax and also the child needs to sit on potty three times a day. Doesn't have to sit for a long time but a few minutes each time. Drink plenty of water as well. You don't want to make the child sit along time as that can only add to the added pressure they are putting on themself. If it has been almost a week the Dr may suggest more mirilax to be able to clean them out. Then maybe a a small daily dose of Mirilax to keep things soft and easier to pass, with sitting 3 times a day. Good luck.

 

[lookame]

I know a lot suggested maybe IBD, want to play devils advocate and ask the questions my son's GI asked me.

when she passes blood, is it mixed within the stool or is it along the outside? Is it bright red or is it darker? unfortunately when it comes to blood and constipation the blood is usually attributed to large, hard stools causing tears.

Water would certainly help in her situation as well as stool softeners. If she won't take water plain will she drink it if it's flavored?

 

[Pilgrim]

My daughter has similar food preferences. Avoids milk, cakes, doughnuts, and bread. She prefers to eat crackers, and apples - mostly. She was initially diagnosed with constipation (like many of the kids) and treated as such for many months before she went seriously downhill, health wise. She also withholds urine as well at times. Something that always baffled me but I guess it's just the not wanting to let go thing.

I agree that a fecal calpro would be really useful. Just in case.

Her activity level seems really low, so that could cause constipation for sure - or it could be a sign that she's too unwell to really want to be active.

 

[Jennifer]

Her doctor doubled the dose of Miralax. Well see how that goes. She still hasn't gone and it's been 6 days. Her mom doesn't want to wait too long if she still won't go and may try a suppository if there's no movement soon. I'm not sure when the followup appointment is.

Her stool from what I'm told is large and hard, kind of a dark brown but not black or dark green. The blood appears to be droplets on the outside from what I'm told and not mixed in with the stool. I'm not sure how willing she is to increase her fluid intake. When I was sick as a kid my mom would come and tell me to take a drink every 15 min and had to have the glass finished by a certain amount of time and then she would give me another (I had diarrhea with blood loss but still important to hydrate). I don't believe they do that with her though.

I think if she continues like this then my sister may request a fecal calprotectin.

Her activity has decreased some. She often asks her mom to carry her but my sister has started to refuse as she knows that she needs to move around.

 

[MamaHenn]

Poor kiddo. A ton of great advice above. As far as getting her to drink more, have them try silly/different cups, crazy straws, etc. When my dd had her tonsils out we had to push the fluids and when she was super cranky, the only thing she drank out of was a stemmed shot glass. We filled that thing up a zillion times but she loved it and it worked! Love the idea of prizes. Dollar stores are great for that kind of stuff. I hope she gets some relief soon.

 

[Lady Organic]

long term constipation also often lead to hemmorhoids which then can also cause bright red blood drops.
The calprotectine test is a good idea to have the mind clear.

maybe there are also some child psychologist who could help in this regard. Constipation can be related to stress and anxiety, combined with pain, at this point, she is going in circle with these variables and maybe a specialist could help relaxing this circle.

osteopaths can also help things moving with tummy manipulations.

 

[Jennifer]

MamaHenn that's similar to what they did with the tiny ice cubes. She enjoys them cause they are cute. Perhaps a few new cute cups could also help increase her fluid intake. I'll suggest it to her mom.

Lady Organic I know that her parents are not interested in any type of therapy at this time.

She did have a BM after 7 days. I'm told it was the size of an adult's fist and that she only let out the plug and refused to let anymore out because she saw blood and it scared her. I'm not sure how they can keep her from looking when she goes otherwise she'll continue to have difficulty fully emptying her bowels and this will continue.

 

[Jennifer]

She was doing pretty well for a little while but just today I found out that she has now gone 10 days without a BM. Her mom was crying today when we came over. When I tried asking my niece how her tummy was feeling she said in kind of a mean tone, "leave me alone." She's never spoken to me that way. She would only lay down and said that she felt cold (it was really hot today). While I was there all she wanted to eat were cookies and milk and refused the applesauce her mom suggested.

I believe her mom said that she was going to try another suppository or enema but I'm not sure if she was going to tonight or what. I suggested taking her back to the doctor and she said maybe.

Our mom suggested that my sister take her to see a psychologist for some therapy to see if that might help (in case this is stress related at all) but my sister refused. I think it would be good to tackle this from all fronts, therapy, tests from the ped to make sure there's no underlying health condition that's causing it (our mom is in favor of this too) along with a major diet change (can only eat certain things and to stick with that without giving her anything that will only make it worse).

Their family is going through a lot so I know that this is added stress and my sister may not know what to do anymore. They certainly can't keep having this happen and just give her laxatives or enemas every so often for who knows how long as it's really not healthy. Plus the scar tissue build up in her rectum is bad news if she keeps tearing after each BM.

Anymore words of advice or support are greatly appreciated. I'll have my sister read your replies so please address your replies as if you were speaking to another mom who's very upset and feels very lost right now. Thank you.

 

[Lady Organic]

im sorry about this situation. may i ask why refusing psychologist evaluation and possible visits? ''therapy'' may sound like a big thing, but sometimes just a few visits may be enough to help her express herself, dont necessarily need to go into extensive, never ending therapy. a lot of ''therapists'' exist nowadays, if they decide to explore this avenue, they have to make sure the psychologist is legit and part of a union and accredited professionnal, some of them specialize in children.

 

[Jennifer]

I'm honestly not sure but I can only guess that maybe it's because her mom had a bad experience with them or perhaps she feels it's too extreme for a 5 year old. I'll have to ask.

I don't think she's against seeing the ped again but I'm honestly not sure if she or the ped want to pursue further testing to see if there might be another underlying cause. If the ped feels that this is common for that age then chances are no testing will be done. Even a simple fecal calprotectin is a reasonable request but if her ped refuses then it may be best to find another one who will take this more seriously. To my knowledge this still hasn't been done.

 

[Catherine]

I am sorry your daughter is in pain.

A couple of things stand out to me. UTI are not normal for little girls. My middle daughter has a condition called urinary reflux. This condition caused her to hold because it hurt.

 

[crohnsinct]

I dealt with chronic and severe constipation with my oldest daughter who happens to be the only one of my three without IBD. It became so severe that she was encopretic and eventually the softer stool would leak out around the hard stool and she would soil her pants daily. Sadly this went on into 6th grade. We found her hiding underwear and such. It was awful and I think I almost went mad with frustration. She eventually had rectal prolapse which believe me is not a pretty sight.

Our docs had us using Miralax to soften things up and get her moving. It was long term therapy and we had to get her to a point where she was going a few times a day, liquid and then VERY slowly reduced the amount of Miralax. We did this to recondition the muscles and her system.

That only works if you address the underlying problems though and her constipation returned. For us it was a combination of things. She started holding her BM's not out of fear or because she didn't want to stop playing but believe it or not because we were always in a rush. Rushing to get to school, to get home, to get to church, meetings, swim lessons etc. She knew it would take her a long time to go so she just chose not to in order to avoid being late. Can you say bad mommy?

So we worked on finding two or three times a day where she could sit nice and relaxed for 10 minutes. If nothing happened so be it. No talk of BM's. Just sit and chat read a book etc and then move on. We also got one of those stools that you put your feet on to raise the legs to put you in a more "natural" position to go...I told you I was desperate.

My daughter's diet was also for garbage. We had to clean it up massively to give her the healthy fiber and fluids she needed. This was a monumental task but I had the help of an amazing doctor. His advice to change a child's eating habits were as follows:

-Find out when they are naturally hungry not when dinner fits best into your schedule. Kids will eat their favorite junky foods even when not hungry but you can forget anything they don't naturally want if they aren't truly hungry.
- pick one new food to introduce at a time (for us the first one was broccoli) everything else stays the same.
- don't talk about it at all just put a little (stress on little) piece on their plate
- if they don't eat it no problem, throw it out, do not discuss it
- it takes about 15 consecutive exposures to a new food for a child to even consider trying it so just keep putting that broccoli on their plate for 15 nights. Eventually they decide it isn't going away so mine as well eat it.
- model good eating. This was hard for me because I despised veggies at the time (now I am a vegetarian...go figure), but I got my own llttle piece of broccoli also.
- delay dinner until they are super dooper hungry and if they ask say something like, "the chicken will be ready in 5 minutes but this (enter broccoli) is ready now if you would like or just put a bowl of it on the table way ahead of dinner.

Believe me I thought this guy was absolutely nuts. Surely he hadn't met me or my daughter. There was no way we were going to change. I kid you not, it didn't even take 15 exposures for her to try that broccoli.

Not really endorsed by him but I also used cheese sauce, dips etc with steamed broccoli to make it more palatable (probably more for me!). Over time I reduced the amount of sauce and dip etc. until she was eating plain steamed broccoli.

She was a day care kid so I also packed breakfast and lunch. I used the same strategy there. Little piece of high fiber fruit with breakfast and one little baby carrot a day for lunch. I also asked the day care workers to help me and her friends moms and by packing some good stuff for themselves and their kids also.

I was working at the time (thus the crappy diet..no time to cook). This was hard and tedious...but at least I didn't have to think about what was for dinner...haha. But it works and all my friends wanted to know how I got such a good eater...I shared the trick with them and it has worked for all but one who ended up having autism and sensory issues.

One other thing to consider is fluids. It doesn't do you any good to increase fiber if you are not also increasing fluids. As a matter of fact, it will back you up even more. A good rule of thumb is half her body weight in ounces. So if a person weighs 100 pounds they should be drinking 50 ounces of water. Summer is a little easier. You can make ice pops. If she won't drink plain water mix a tiny bit of juice in there. Let her help make the pops in those dollar store molds you can buy. 3 or 4 of those pops a day probably equals 8 ounces and they think it was just a treat.

All this said, my youngest had issues with constipation. She was 8 when her older sister was dx'd. I mentioned her to the ped and the GI and was written off with chronic constipation. This went on for three years and during that time we became vegetarian and she was getting about 50 grams of fiber a day and only drank water and lots of it. Finally her disease started showing symptoms (no weight gain in a year) and someone ok's a fecal calprotectin test and her numbers were off the charts, scopes and dx soon followed.

The fecal calprotectin test is easy, non invasive and gives very useful information. With a family history of IBD, I would think your pediatrician or a ped GI would certainly order it. If it is normal great! One less worry and you can move on. If not, then great, you get to control the dx. With my older daughter the disease controlled the dx as it wasn't on our radar at all. She got deathly ill very fast and ended up in ICU. It was messy. With my youngest we controlled the dx and it was a much more pleasant experience. I encourage you to get the test. Knowledge is power!

Good luck! I hope this helps! Feel free to pm me if you have any questions.

 

[kimmidwife]

Crohns instinct,
Thanks for sharing that with us!

We dealt with a similar issue with our youngest as well. We ended up giving her miralax daily. The nice thing about miralax is you can add it to anything and it has no taste. She used to drink it in chocolate milk.
We did do a fecal calp On her because she gets bloody stools on and off but so far it has been negative. We basically are just watching her. Eventually her constipation got better.
One of the things we did do was hang a calendar in the bathroom and she got to put a sticker on it when she went. We didn't discuss it though we would check it when she wasn't looking. Then when she went consistently (at least every other day) she would bring us the calendar and would get to go to the store and pick out something special. This really helped her.
Have you tried something like this?

 

[crohnsinct]

My only warning about a calendar/reward system is if she is terribly backed up that could encourage straining and pushing to hard and resulting in rectal prolapse...ask me how I know.....however, the calendar reward system would work if she got a sticker for every time she went and sat for a specified period of time, regardless of outcome.

When my daughter was younger (around 5 or 6), I went with her to the bathroom and stayed with her for the ten or so minutes. We chatted, sang songs, read books etc. This way she wasn't so isolated and had company...and I knew she was actually on the potty iykwim...that alone time with mom eventually became the reward.