Help - My 3-year-old has chronic rectal pain - could it be a food allergy?

[lee-sinkorswim]

I'm at my wits end, and I stumbled across this site/forum today, and I'm hoping someone can help.

My 3-1/2 year old daughter has been suffering all summer with chronic rectal pain. Here are the details:

- She wriths in pain and cries/screams when they happen, and they are short in duration (less than a minute). She's not a crier/screamer in general.
- They happen most frequently first thing in the morning, before bed, or in the middle of the night
- They don't seem to occur at pre-school, which might be due to time of day or lots of activity/distraction?
- They started out of the blue and were bad right away
- She still goes to the bathroom just fine, and there is no pain when she actually pees or poops. She has had no diarrhea. One issue is that lately, she does not seem to be able to get all of the stool out of her system, but she still uses the bathroom very regularly.

She has been tested for pinworms, giardia, parasites, blood/mucus in stools, etc., and all come back negative. She's had an ultrasound and C/T scan to rule out blockages/other issues, and nothing there either.

Our Pediatric Gastroenterologist is leaning toward Proctalgia Fugax (http://en.wikipedia.org/wiki/Proctalgia_fugax) as a diagnosis, but that doesn't feel right to me, especially with a toddler. Our next step involves putting my daughter under to insert a flexible scope to search her colon, and I'm hoping we don't get to that point.

I've discussed food allergies with the doctor, and he's clearly a skeptic. The food diary I've keep doesn't seem to point to anything specific, but considering that there is dairy in quite a few things she eats, I'm starting to suspect that could be the issue. She has shown no beahvioral issues related to these pains, and other than when she is in pain, she's been her normal, happy self this summer. And she has never shown the slightest sensitivity to dairy or any other food group in the past.

As a side note, she is Asian, and I know lactose intolerance is more common in Asians, although kids don't ususally experience it before adolescence.

We've tried eliminating dairy, but wow, is that ever tough! It seems to be everywhere, but we are re-committing to trying it.

I'm looking for thoughts/answers on the following:

- Does this type of pain match up with allergies/food intolerances that anyone here has experienced in their child/ren? Celiac? Dairy? Anything else?

- What is the difference in terms of symptoms/solutions for lactose intolerance and an allergy to milk?

- Once we do eliminate a food, how long should it normally take for there to be an improvement in her symptoms?

Any thoughts are appreciated. This has been the most frustrating summer I've had as a parent. Thanks in advance --

Lee

[JaneS]

Well *I* had some of these symptoms esp. the pain and incomplete emptying. Probiotics were the solution, both supplementing and raw milk kefir.

What about trying lactase drops (enzyme that breaks down lactose) with dairy or lactaid milk first? My understanding is that not producing lactase yourself, is relative to your gut flora. I'm really not sure how Asians particularly develop gut flora that tends to be less likely to break down lactose but from how the body works, our gut flora is not influenced by genetics but by diet and the environment and people around. Are you lactose intolerant?

I will also tell you I have met *countless* people in my raw milk coops over the last 4 years who cannot drink pastuerized milk and can drink raw b/c it contains the live enzymes to digest lactose. I think pastuerized milk is not natural for the body just like breastmilk is much easier than formula to digest b/c it too is raw!

Yes to celiac, I know some of these symptoms sound like my friends DD with celiac.

Is her stool dark brown and formed? Is it smelly?

I understand your frustration, your poor little one!

[JaneS]

And I will add that the dx of Proctalgia Fugax seems to be at first glance to be "I don't know exactly what the heck is going on but I'm going to give it a long serious sounding name"!

Kind of like diagnosing "Irritable Bowel Syndrome" when those who study allergies, intolerances, digestion and gut flora outside of the blinders mainstream medicine has on know that there are MANY pretty simple causes that lead to that diagnosis. IBS dx is meaningless b/c it doesn't tell you a cause, it just tells you what the bowel is doing, ykwim?

Good luck finding her cause!

[JaneS]

Sorry, keep thinking of things.

Any antibiotics recently?

[kjbrown92]

The other thing is if you suspect dairy, take out dairy COMPLETELY. After a few weeks, if all the symptoms disappear then you know it's part of the milk. Then you can try her on Lactaid milk and see if she's okay with that (then you'll know it's only the lactose) or try her on raw milk and see if she's okay with that (then it's the pasteurization process, which I think hinders the ability for the body to digest the milk).

To me, it seems like ANY food can cause ANY reaction. The reactions on this forum run the gamut. If they've ruled out parasites and structural, etc., it certainly doesn't hurt to try no milk for a few weeks. Or no milk and gluten (second most popular).

[lee-sinkorswim]

I would say that today is our first day when we have 100% eliminated dairy. I feel like a horrible parent that I haven't been more strict about it prior to this, but as someone with no food intolerances herself, it is hard to keep it at the front of your mind. Now, it is always front and center.

We're going to try this for a couple of weeks to see how it goes. I was looking at the pro-biotics at Walgreen's today, and that idea intrigues me. Anything specific you recommend.

I think Celiac can be determined with a simple test, yes? To the question about her stools, they have been very normal (formed, brown, normal smell), which is what is confusing to the doctors. We have been softening her stools with Miralax based on the Ped Gast recommendation, but I am hesitant to give her more than 1/2 a dose. Nasty stuff, and it doesn't hurt when she poops anyway. And no, she's not been on antibiotics.

We'll try no milk for a couple of weeks, but we are giving her soy. That's sometimes an issue as well, yes? If no success, gluten is next.

We tend to be on the go and eat out a lot, so this is an added challenge. But we'll give no dairy at least a couple of weeks. Thanks for the comments, and any other ideas are still very welcome!

[mamafish9]

Unless she's had a lot of soy in the past, I definitely wouldn't replace dairy with soy. I know it can be more difficult to pull both, but you should see some results in a week or two.

And I'd stop the Miralax, personally, if her poops aren't hard without it. It is nasty stuff...

For probiotics, you need a dairy free strain - and likely nothing at Walgreen's meets that standard. I'm sorry, I'm not up on probiotics - we make kefir (water kefir grown in juice is yummy and inexpensive and often more effective than pill probiotics).

Good luck, I hope dairy free helps for your daughter!

[Dawn24]

lee-sinkorswim, Did you ever find out anything - a diagnosis or anything that helped?  My 3 year old daughter just started having pain that sounds just the same.  I know it's been a while, but any info would help - thank you!!

[lee-sinkorswim]

Dawn -- seems like a lifetime ago! 

It seems a bit obvious in retrospect, but my daughter's pain started shortly after she was poop potty trained.  Turns out, she was not fully eliminating, and her stool was backing up.  This eventually caused a small infection, which made it very painful to eliminate her stool, making the problem even worse.  We finally ended up at the Mayo Clinic, where they did a flex scope as well as an upper GI.  It seems terribly invastive in retrospect, and it was, but without the procedures, they may never have found the infection, and we also might never known that she is quite lactose intolerant.  We initially eliminated dairy entirely, but we have been able to re-introduce whole milk items in small doses, and aged cheeses in small doses.  So I just make pizza at home with whole milk mozzarella and she can have a cheese on her pasta, etc.  She can even have small amounts of ice cream.  Again, as long it is a high-fat dairy, we've been fine.  No DQ, no ice milk cones/bars, and absolutely no skim or lowfat milk in a glass (which was not a big loss for her).

She is completely her old self again.  We keep her on a high fiber diet and supplement with pediatric stool softeners if she hasn't had a good bowel movement in a while.

Are you in the process of potty training, or was she potty trained recently?  It really might be as simple as chronic constipation!

Lee

[Dawn24]

Lee,

Thanks so much for the info!  I'm so glad your daughter is fine now!

It sounds like our situation may be a bit different.  It just started about a week and a half ago.  (She's been potty trained for about a year now.)  She has fine regular bowel movements, no bleeding or constipation or parisites (that I can see).  The first time, she said her bottom hurt where she goes poo-poo, but it wasn't severe, just curious & she wanted me to put something on it.  The next day the same thing happened.  Then the next day it was painful to where she was saying "ow! ow! ow!" and kicking her legs =(   It only lasted a minute or two, then all was fine.  The next day the same thing happened, only this time it was immediately after having a bowel movement - again only lasting 1-2 minutes.  All these times were around noon/early afternoon.  The next day nothing happened, then the next day it was painful again & right after a bowel movement.  Then nothing for another day (and more fine bowel movements), then last evening she said it was hurting, but forgot about it with distraction, so it wasn't bad. 

I don't know what to think.  Haven't been to a doctor (yet), and hoping it will just go away, since it doesn't seem like a simple visit would clear anything up... 

Thanks again!

Dawn