Hi,
The history is suggestive of the following:
- Considering the history and age of the child there looks to be condition called fissure-in-ano. In this condition there is small wound at the front and / or back part of anus and is very painful while passing motion. This is the commonest reason that the child gets fear to pass motion and is certainly painful particularly on passing hard stools.
Hence, I would advise the following in such a situation:
- First of all get the anal area examined for any fissures, excoriation of skin,
redness or so. If yes, then better to consult a Gastro or Pediatric surgeon to get a proper examination and advise. Sitz bath meaning sitting in a warm water before and after passing motion.
Stop
Miralax as it is giving cramps and try another laxative suitable for a 4 year old child, ask your doctor. Watch for the diet that gives hard stool or
constipation and stop these. Green leafy vegetables and high fiber diet with plenty of oral fluids helps a lot.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. T. Chandrakant, General Surgeon