Painful Bowel Movements - Pediatric Oncall

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Question
I have a 3 1/2 year old daughter, that has had painful bowel movements about once every month or two since the age of approx. 6 months. She has been having problems every day or so for the past 5 weeks. Her stools are not hard, but she screams in pain while passing them. A few days ago, I noticed a little blood on the tissue after I cleaned her. A phone call from her pediatrician stated that this was normal, and could be from a tear in her rectum. Tonight, after a painful bowel movement, there was a lot of blood in the commode, along with a normal amount of soft stools. I rushed her to the emergency room, and the doctor stated that there were no tears around her rectum, and that she had a lot of blood clots still inside her rectum. He is referring her to a gastroentologist. Until then, can someone please tell me what could be causing this? Her pain goes away after each bowel movement, but is present before and during the actual passing of the stool. Thank you.
Answer
The most common cause of painful stools with blood in stools are fissures, anal fistulas and piles. If the stools are covered with blood on the outside and not mixed inside it is suggestive of fissures. If the blood is admixed with stools it is more suggestive of piles. The best way to differentiate would be to do a rectal examination. Till then she would require a stool softener such as milk of magnesia as the harder the stools, more would be the straining and severe the fissure of piles. Back to All Questions

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