Expert: Moshe Adler, MD - 4/14/2004

Question
Dear Dr. Adler,

My daughter, now 3, not currently taking any medications, generally healthy, except for the colds she brings home from day care now and then, has been doing well at using the potty on a regular basis.  However, I started to notice a discharge in her underwear, then she developed a rash covering her anus and vagina. I treated it with Balmex and it was gone in a few days. Last night she had a bowel movement on the potty and started screaming that she had a rash and it hurt. When I looked at her stool initially it was fairly big and thought it just hurt her. Then when I wiped her I noticed blood. When I lifted her off the potty I noticed blood in the stool. When I layed her down to see if there was a rash that had broken I saw nothing. Should I take her to her pediatrician, the hospital, or a specialist? Thank you for addressing this.

Answer
You should start by seeing her pediatrician.  Most of these cases are a small tear just inside or at the opening of the rectum, and it is really common in constipated children.  Try apple, pear or prune juice to keep her stools looser, and continue some Balmex if she has a rash.  If this is a recurring problem, she may need to see a pediatric GI specialist.  

Moshe Adler, MD