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Suggest Treatment For Rectal Pain In Child

Posted on Wed, 25 Mar 2015

Question: My son has been complaining of rectal pain since dec5,2014. His pcp has treated him & took stool sample & had yeast in his stools. So he prescribed nystatin sol

He continues to have rectal pain. I am deeply concerned. There is no redness or irritatiion. What could this be?

Answered by Dr. T Chandrakant (48 minutes later)

Brief Answer:
Evaluation and examination by a Specialist / Investigations.

Detailed Answer:
Hi.
Thanks for your query for your son.
To recapitulate: Male / 17 - rectal pain since Dec 5, 2014 - PCP treated - stools sample shows yeast- Nystatin Sol - continues to have rectal pain - no redness or irritation - Wants to know the reasons ...

The most probable causes of rectal pain in your boys are:
- Proctitis, meaning inflammation of the rectum with or without colitis
- Prostate inflammation, congestion , prostatitis
- Part of the IBS - Irritable Bowel Syndrome
- Thrombosed piles or so- but can not have pain for so long

I would advise you the following:
- Clinical evaluation, actual physical examination by a General Surgeon / Surgical Gastroenterologist / Proctologist.
- Per-rectal digital examination of the are with palpation of the prostate is basic and very important examination.
- Ano-proctoscopy and colonoscopy to start with, with biopsy of the rectum.
- CT scan or MRI of the pelvis and abdomen can help in further diagnosis.

The treatment will necessarily be based on the diagnosis hence made. Give him hygienic food and cleaner drinking water to avoid water borne conditions.
Please discuss with your Doctor / Specialist whether this is a somatic (actual physical problem) or Psycho-somatic problems (akin to IBS).

I hope this answer will help you both to get a proper diagnosis and hence the more accurate treatment.
Please feel to ask for relevant further questions if you need to or if you feel that there is a gap of communication to clear any doubts you have.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. T Chandrakant (7 hours later)

It would not let me click on my sons age he is 3 years old. Born 11/30/11. Can these exams be done on him bcuz of his age? I mean the checking of the prostate?

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
Consult a Pediatric surgeon

Detailed Answer:
OK !
The patient is just 3 years old.

What is the exact way he explains or tell you the pain he has ?

The only best solution can be to consult a Pediatric Surgeon for proper evaluation and physical examination and treatment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (7 minutes later)

He says mom my butt hurts & cries. So I put proctosol crm externally only as prescribed & if it still doesn't go away then I have to give him Tylenol or Motrin for pain & then it goes away. But he doesn't do this everyday it's random. For instance it's been about 2 weeks since he complained.

Answered by Dr. T Chandrakant (8 minutes later)

Brief Answer:
May be anal fissure / Hoe is the stool ?

Detailed Answer:
You have already mentioned that the complaint is since Dec 5 last.
Since your son says that the butt hurts, means there is a problem and the exact reason can be known only by examination, particularity when he is in pain.

The commonest reason in a child of 3 can be:
Anal fissure or peri-anal excoriation. This can be seen if you separate the butt to see the anal opening. (although you have mentioned there is no redness or irritation in the first question.)
A course of an antibiotic, Metronidazole, probiotic may help, but you need a valid prescription from your Doctor. You may please discuss this with your Doctor.

How is the stool at the moments ? Is it normal color/ small and consistency ?
You may please recheck the stool in laboratory.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (8 minutes later)

His stools r soft has never had problems with constipation. He eats lots of fruits & juice. He had a stool test already which indicated yeast which is why we did a 14 day course of nystatin sol by mouth.his stool has been lime green or yellow in color but looks normal

Answered by Dr. T Chandrakant (3 minutes later)

Brief Answer:
Lime green can be indicative of an infection

Detailed Answer:
Good that there never have been constipation and you have already completed the course of Nystatin sol.

Lime green color can be indicative of an intestinal infection. It would be advisable to get stool test done again.
We may ask for 3 tests as some test may miss something that the other can get it.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (5 minutes later)

Ok good to know. Yes I finished nystatin course 2 weeks ago for a 2 week treatment. I will take him back to pcp bcuz I do not have ins to take him to a pediatric surgeon. Thank u for your advice it has been very helpful.

Answered by Dr. T Chandrakant (2 minutes later)

Brief Answer:
Please discuss PCP and ask to check for anal fissure and stool tests and Rx

Detailed Answer:
This is a god decision on your part and you may please discuss all the points I have mentioned.

You may please rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakant

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar