Pediatrics/5.5 year old daughter with occasional severe abdominal pain & sudden bedwetting
QUESTION: Hello Dr. Olson,
My daughter is 5.5 years old and is pretty healthy overall. She usually has a great appetite and eats a variety of fruits and vegetables every day. I limit - but don't forbid - candy and other snacks. She typically drinks only milk and water, though will occasionally have a glass of juice. She's tall & thin and is rather active. She usually has one bowel movement a day (often around dinner time) which is formed but soft. She will occasionally not go for a day, and when that happens, her stool is usually harder and sometimes even a bit 'pebbly' (for lack of a better description). But that is always short-lived, and though she occasionally strains a bit, she has never complained of pain then.
In early December, her school called to say she was having abdominal pain (left side). When I picked her up from school, I saw that she was hunched over to walk. Even sitting upright in her booster seat for the short ride home was very uncomfortable for her. Once we got home, she immediately asked to use the bathroom and had a very normal soft/formed bowel movement. She felt better right away and inhaled the lunch she didn't get to eat at school. I thought this was a one-time thing and didn't think more about it.
Then, on January 1st, my daughter woke up feeling fine, though she had slightly soiled her underwear (which she has never done since being potty-trained). But about an hour later, she was once again doubled over in pain. She pointed to the left side, very close to her hip bone, as the area that hurt. She spent much of the day laying down on her right side. She asked me to carry her several times during the day. When she tried to walk, she was hunched over again, just as she had been when she had abdominal pains at school. At one point later in the day, she said the pain was right around her belly button. Just before dinner, she had a bowel movement (formed/soft with no blood or mucus) and was finally completely pain free again. She never had a fever or exhibited any other symptoms other than abdominal pain.
Since that time, she has continued to eat and behave normally. The only change has been that she's wet the bed 3 times in the past week. (She has been fully dry all night since May 2012.) She hasn't had any urinary incontinence during the day.
Then, this afternoon while playing a board game with me, she immediately doubled over in pain again and said she had to use the bathroom. (She had already had a bowel movement this morning.) She sat on the toilet for some time, but did not go. Her pain didn't seem as bad this time, and she did eat a small dinner. She said it felt just like it did before, but this time pointed to right above her belly button as the painful area.
Do you feel this could be constipation, though she doesn't have the 'typical' symptoms? I've read that some children with constipation have urinary incontinence due to the pressure of the stool. Or could this even possibly be a urinary tract infection? Gas pains? Other thoughts?
I'm not sure if this even warrants a visit to her pediatrician, as the pain comes out of nowhere, at different times of the day. Do you feel a visit to her doctor would be best though? I know abdominal pain is common childhood complaint, but it's never been for my daughter before so these 3 episodes do have me concerned.
Thank you so much for your professional advise!
ANSWER: Hi, Jennifer,
With the combination of intermittent L sided pain and the urinary symptoms, she almost certainly is constipated, but not in the classic hard/infrequent way. A term that has been recently used is "occult megacolon" and describes a group of kids who have a large amount of stool in the colon, never completely empty, and as a result, have bladder dysfunction.
Try a cap of Miralax (PEG 330)in 6 oz of liquid two times a day for two days as a cleanout dose and then maintain things with a cap every day for a month or two, to have the bowels become regulated.
If this doesn't work, then see your doctor, but I'm almost certain this is the answer.
Good luck, Dr. Olson
---------- FOLLOW-UP ----------
QUESTION: Hello again, Dr. Olson,
Thank you so much for your quick reply and advise! I will go out tomorrow and buy Miralax so she can start this regimen.
One question about the Miralax though - during the "cleanout dose", will she likely have explosive diarrhea or not be able to control the urge to use the bathroom? Knowing this will help me decide if we should start using Miralax tomorrow or wait until the weekend when she's home from school. Ideally I would like to begin right away to prevent her from having any additional pain; however, I know she would be mortified if she had an accident at school.
Although the approach is usually very gentle, most of the time I do recommend the cleanout over the weekend. It would be reasonable, if you wish, to have her home for the first day with you and then as it is proven that things are fine, have her go to school for the second day. This would speed things up for you.
Good luck, Dr. Olson