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What Causes Chronic Constipation Post Viral Fever?
Question: Hi Doc,
My 5 yr old daughter had a viral fever in Nov'2013 accompanied with stomach ache. Post (she never had constipation earlier) this fever she had a constipation that became acute and due to passing of a hard stool she started holding the stools. Things became worse and often only small amount of stool would soil the underwear. This also lead to small cuts in the skin around the anus and she could barely walk straight.
We showed to a doctor in Manipal who recommended Cremafin for 1 month. We continued that she was fine for next 2 months. Her diet was constantly monitored and we took all the precautions.
This weekend she had food outside (popcorn/chips) and once again the same condition has occurred. She has cuts and today she also had anal bleeding (When wiping the anus post stools there was blood on the swipes). We are continuing Cremafin and for the cuts in skin been using Annovate ointment.
We find her stomach bloated as well. Not sure if it is due to the stool in rectum or something else. Do you recommend a ultrasound scan?
I would like to know a doctor who can diagnose the condition and associated treatment.
My 5 yr old daughter had a viral fever in Nov'2013 accompanied with stomach ache. Post (she never had constipation earlier) this fever she had a constipation that became acute and due to passing of a hard stool she started holding the stools. Things became worse and often only small amount of stool would soil the underwear. This also lead to small cuts in the skin around the anus and she could barely walk straight.
We showed to a doctor in Manipal who recommended Cremafin for 1 month. We continued that she was fine for next 2 months. Her diet was constantly monitored and we took all the precautions.
This weekend she had food outside (popcorn/chips) and once again the same condition has occurred. She has cuts and today she also had anal bleeding (When wiping the anus post stools there was blood on the swipes). We are continuing Cremafin and for the cuts in skin been using Annovate ointment.
We find her stomach bloated as well. Not sure if it is due to the stool in rectum or something else. Do you recommend a ultrasound scan?
I would like to know a doctor who can diagnose the condition and associated treatment.
Brief Answer:
Consptipation
Detailed Answer:
Hi...Thank you for consulting in Health Care magic. I think your kid is having habitual constipation. I have certain questions and suggestions for you.
Questions:
1. Did your kid pass motion or meconium on day one of life?
2. Since how long is the kid constipated?
3. How much milk does the kid consume per day?
4. Does the kid eat fruits and vegetables (fibre diet) appropriately?
Suggestions:
1. Natural methods are the best to relieve constipation.
2. Constipation is a risk factor for UTI
3. Maximum milk consumption per day should not exceed 300-400ml
4. Minimum 3-4 cups of fruits and vegetables to be consumed per day
5. Toilet training - that is - sitting in XXXXXXX type of lavatory daily at the same time will help a lot.
Your queries -
1. I don't recommend Ultrasound as it is a very inferior modality to diagnose pathology of constipation.
2. If I was your treating doctor I would refer you to a paediatric surgeon to rule out Hirschsprungs disease.
Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).,
Consptipation
Detailed Answer:
Hi...Thank you for consulting in Health Care magic. I think your kid is having habitual constipation. I have certain questions and suggestions for you.
Questions:
1. Did your kid pass motion or meconium on day one of life?
2. Since how long is the kid constipated?
3. How much milk does the kid consume per day?
4. Does the kid eat fruits and vegetables (fibre diet) appropriately?
Suggestions:
1. Natural methods are the best to relieve constipation.
2. Constipation is a risk factor for UTI
3. Maximum milk consumption per day should not exceed 300-400ml
4. Minimum 3-4 cups of fruits and vegetables to be consumed per day
5. Toilet training - that is - sitting in XXXXXXX type of lavatory daily at the same time will help a lot.
Your queries -
1. I don't recommend Ultrasound as it is a very inferior modality to diagnose pathology of constipation.
2. If I was your treating doctor I would refer you to a paediatric surgeon to rule out Hirschsprungs disease.
Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).,
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answers to your questions inline.
1. Did your kid pass motion or meconium on day one of life?
[Mayank] Yes
2. Since how long is the kid constipated?
[Mayank] This condition started only after the viral fever in Nov 2013. I'm not sure if it is indeed constipation. She essentially holds the stool (out of fear and experience she had in Nov 2013) and then for few days the stool comes out in small quantities 7-8 times a day. This causes fissures/skin cuts around anus and is very traumatic for her.
3. How much milk does the kid consume per day?
[Mayank] 2 cups a day
4. Does the kid eat fruits and vegetables (fibre diet) appropriately?
[Mayank] She just loves fruits and vegetables. In fact she has all vegetables including spinach and other leafy vegetables. She doesn't eat a lot of junk food either. That's the reason we are very surprised as to why this condition. Throughout her eating habits have been good. Every day in the morning she used to pass regular stools. It's only after the viral fever in Nov'2013 that this condition started.
1. I don't recommend Ultrasound as it is a very inferior modality to diagnose pathology of constipation.
[Mayank] Is this really constipation? I wanted to understand if anything has gone wrong with her stomach/intestines/colon etc. But if you are confident that it is not required then I would trust you.
2. If I was your treating doctor I would refer you to a paediatric surgeon to rule out Hirschsprungs disease.
[Mayank] I was referred to a paediatric surgeon at Manipal. He got an enema done and asked us to give Cremafin for a month. After that things were normal (that was in Feb 2014) and now again it has started. So we really are not sure what's the trigger and were wondering if it is indeed due to the popcorn/chips she had the other day. Since Feb'2014 she was perfectly fine with regular bowels in the morning.
Do you still recommend that we visit the paediatric surgeon?
1. Did your kid pass motion or meconium on day one of life?
[Mayank] Yes
2. Since how long is the kid constipated?
[Mayank] This condition started only after the viral fever in Nov 2013. I'm not sure if it is indeed constipation. She essentially holds the stool (out of fear and experience she had in Nov 2013) and then for few days the stool comes out in small quantities 7-8 times a day. This causes fissures/skin cuts around anus and is very traumatic for her.
3. How much milk does the kid consume per day?
[Mayank] 2 cups a day
4. Does the kid eat fruits and vegetables (fibre diet) appropriately?
[Mayank] She just loves fruits and vegetables. In fact she has all vegetables including spinach and other leafy vegetables. She doesn't eat a lot of junk food either. That's the reason we are very surprised as to why this condition. Throughout her eating habits have been good. Every day in the morning she used to pass regular stools. It's only after the viral fever in Nov'2013 that this condition started.
1. I don't recommend Ultrasound as it is a very inferior modality to diagnose pathology of constipation.
[Mayank] Is this really constipation? I wanted to understand if anything has gone wrong with her stomach/intestines/colon etc. But if you are confident that it is not required then I would trust you.
2. If I was your treating doctor I would refer you to a paediatric surgeon to rule out Hirschsprungs disease.
[Mayank] I was referred to a paediatric surgeon at Manipal. He got an enema done and asked us to give Cremafin for a month. After that things were normal (that was in Feb 2014) and now again it has started. So we really are not sure what's the trigger and were wondering if it is indeed due to the popcorn/chips she had the other day. Since Feb'2014 she was perfectly fine with regular bowels in the morning.
Do you still recommend that we visit the paediatric surgeon?
Brief Answer:
Constipation is not a once in a life phenomenon
Detailed Answer:
Hi XXXXXXX ... I am happy for your trust in me.
I still feel by what you quote that it is constipation but probably secondary to the painful defaecation due her fissures. I am happy that you got to the point yourself.
Usually what happens in constipation is that it is a vicious cycle -
The kid gets constipated - stools become hard - it makes the stool to come out a painful process - kid gets scared of the pain - she tens to hold back the stool to avoid pain during passing it - but feeding continues and more stool forms and again the whole process repeats itself. this is the basic pathophysiology of habitual constipation which I was referring in my last suggestion.
You are 100% right - out of fear she is holding back and in the process she has developed fissures which have things worse.
Trust me - You need not do Ultrasound.
As you mention she has passed stools on day 1 of life and she was never consptiapted before - unlikely to be Hirschsprungs disease. But it can only be certainly ruled out after a screening of barium enema and the confirmation only after a biopsy and histopathological examination.
My suggestions -
I feel her constipation is going to be a chronic affair due to the fear factor. She will need laxatives for ta period of 6 weeks to 3 months and under medical supervision time to time. I recommend to directly visit a gastroenterologist as I will not be in position to examine her directly and do the needful.
I wish your kid a speedy recovery. If you are happy with my suggestions, please rate my suggestions. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. Please find the link below.
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696
Constipation is not a once in a life phenomenon
Detailed Answer:
Hi XXXXXXX ... I am happy for your trust in me.
I still feel by what you quote that it is constipation but probably secondary to the painful defaecation due her fissures. I am happy that you got to the point yourself.
Usually what happens in constipation is that it is a vicious cycle -
The kid gets constipated - stools become hard - it makes the stool to come out a painful process - kid gets scared of the pain - she tens to hold back the stool to avoid pain during passing it - but feeding continues and more stool forms and again the whole process repeats itself. this is the basic pathophysiology of habitual constipation which I was referring in my last suggestion.
You are 100% right - out of fear she is holding back and in the process she has developed fissures which have things worse.
Trust me - You need not do Ultrasound.
As you mention she has passed stools on day 1 of life and she was never consptiapted before - unlikely to be Hirschsprungs disease. But it can only be certainly ruled out after a screening of barium enema and the confirmation only after a biopsy and histopathological examination.
My suggestions -
I feel her constipation is going to be a chronic affair due to the fear factor. She will need laxatives for ta period of 6 weeks to 3 months and under medical supervision time to time. I recommend to directly visit a gastroenterologist as I will not be in position to examine her directly and do the needful.
I wish your kid a speedy recovery. If you are happy with my suggestions, please rate my suggestions. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. Please find the link below.
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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