Pediatric Abdominal Pain Linked to Bowel Movements

Thinking about having a bowel movement causes abdominal pain?

Dear Dr.
Hsiao,
Thank you for taking the time to answer my questions despite your busy schedule.
My child is 3 years old and has been complaining of stomach pain whenever he feels the urge to have a bowel movement for the past two weeks.
Initially, for two days, there was blood in the stool, which appeared in strips or lumps.
Later, he developed a fever, and his cardiac enzymes were slightly elevated, with a white blood cell count of 18,000.
The doctor recommended hospitalization for an abdominal CT scan and an echocardiogram.
However, after two days in the hospital and a repeat blood test, his stool returned to normal, so the scans were not performed.
An earlier abdominal ultrasound was normal, but the stomach pain has not improved.

At first, he was taking one softening laxative (Sennoside A+B calcium) before bed each night, along with 10cc of Aluminum magnesium suspension three times a day and three Lactobacillus casei capsules daily.
During the first week, his stool was sometimes softer but still formed.
Later, the doctor advised against the laxative and suggested waiting 2-3 days without a bowel movement before taking it again.
Now, he only takes the Aluminum magnesium suspension three times a day (10cc each time) and three Lactobacillus casei capsules daily.
He has bowel movements almost every day, 2-3 times, with the stool being lumped, not very soft, and varying in color, including dark brown.
There was one day this week without a bowel movement, and the next day the stool was quite hard.
He continues to experience stomach pain whenever he feels the urge to have a bowel movement.
I would like to ask the doctor:
1.
After taking the medications for about three weeks, there has been little improvement in bowel movements and abdominal pain.
What should we do? Is it concerning to take Aluminum magnesium suspension and Lactobacillus casei long-term? Is one month considered a long time?
2.
The previous doctor mentioned that he has difficulty with bowel movements.
My child currently eats papaya and bananas, has two meals a day, drinks 400-500cc of goat milk, and very little water.
How much water should he be drinking daily to be considered adequate?
Thank you very much.
Sincerely,
A worried mother

Shan Zhuo, 30~39 year old female. Ask Date: 2009/03/23

Dr. Xiao Kaiwen reply Pediatrics

1.
There is no specific amount of water that children should drink daily, as it depends on their sweat output.
The principle is that urine output should be moderate, and stools should not be hard (in fact, increasing fluid intake for children over three years old is generally harmless).

2.
For constipation, it is important to consume plenty of fiber-rich vegetables and fruits, drink more water, and establish a daily bowel habit.
When there is a need to go, children should not hold it in; they should have a complete bowel movement rather than just passing a small amount and then stopping.
Long-term use of antacids and probiotics is acceptable, but it should be done under a physician's prescription.
3.
There are many causes of abdominal pain in children, with constipation being a common one.
In addition to ultrasound, other examinations such as abdominal X-rays, blood tests, gastrointestinal contrast studies, and CT scans can provide valuable information, which can be discussed with a physician.

Reply Date: 2009/03/23

More Info

Dear concerned mother,
Thank you for reaching out with your child's abdominal pain and bowel movement issues. I understand how distressing it can be to see your child in discomfort, especially when it seems that treatments have not provided the relief you hoped for. Let's break down the situation and explore possible avenues for improvement.

Understanding Pediatric Abdominal Pain Linked to Bowel Movements
Abdominal pain in children, particularly when associated with bowel movements, can stem from various causes. In your child's case, the pain seems to be linked to the act of trying to defecate, which may indicate a few potential issues:
1. Constipation: This is a common issue in children and can lead to pain during bowel movements. When stool becomes hard and dry, it can cause discomfort and even bleeding, as you've noted. The presence of blood in the stool, especially if it appears as streaks, can be alarming and often indicates that the stool is too hard, causing small tears in the rectal lining (anal fissures).

2. Dietary Factors: The diet plays a crucial role in bowel health. While fruits like papaya and bananas are generally good for digestion, it's essential to ensure that your child is consuming a balanced diet rich in fiber. Additionally, adequate hydration is vital. Children typically need about 5-7 cups (or around 1.2 to 1.5 liters) of fluids per day, depending on their age, activity level, and climate. If your child is not drinking enough water, this could exacerbate constipation.

3. Psychological Factors: Sometimes, children may develop a fear of bowel movements due to previous painful experiences. This can create a cycle where they hold in their stool, leading to further constipation and pain. It’s important to create a positive and relaxed environment around bathroom time.

Treatment Considerations
1. Medication: You mentioned that your child has been on Sennosides (a stimulant laxative) and aluminum magnesium suspension (an antacid). While these can be helpful, long-term use of stimulant laxatives is generally not recommended for children as it can lead to dependency. It might be worth discussing with your pediatrician the possibility of transitioning to a more natural approach, such as increasing dietary fiber and hydration.

2. Dietary Adjustments: Encourage a diet high in fiber, including whole grains, fruits, and vegetables. Foods like prunes, pears, and apples can be particularly effective. Additionally, ensure that your child is drinking enough water throughout the day. You might consider introducing a water bottle to make drinking more appealing.

3. Behavioral Strategies: Establish a regular bathroom routine, encouraging your child to sit on the toilet for a few minutes after meals. This can help create a habit and reduce anxiety around bowel movements.

4. Follow-Up Care: Since the pain persists despite treatment, it may be beneficial to revisit your pediatrician or a pediatric gastroenterologist. They can assess whether further investigations are necessary, such as checking for underlying conditions like functional gastrointestinal disorders or anatomical issues.

Conclusion
In summary, while it can be frustrating to see little improvement, focusing on dietary changes, hydration, and creating a supportive environment for bowel movements can significantly help. If symptoms persist, do not hesitate to seek further medical advice. Your child's health and comfort are paramount, and with the right approach, you can help alleviate their discomfort.

I hope this information provides you with some clarity and direction. Please take care, and I wish your child a speedy recovery.

Best regards.

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