Hello & welcome to Just Answer! If you have any questions after reading my answer, be sure to let me know.
How is her stool, is it soft/ runny/ firm or hard?
Is the pain specifically linked to passage of stools?
Is she otherwise toilet trained?
Was a biopsy done to rule out Hirschsprung's Disease?
Please answer the above questions so that I can assist ...
she is completly normal befor 6 months and had good toilet training apart from constipation due to formulla feeding
no sign and symptom of hirshsprung disease and no biopsy done because iam also pediatrician but i failed to find solution
If she was absolutely normal before 6 months, then possibly a biopsy would not be all that important
but it may be considered in these circumstances,
If the stools are firm to hard, and the pain is related to passage of stools, then we need to treat the constipation aggressively,
use of Pegolac (or similar preparations like Macrogol etc.) should be considered in moderate to high doses to cleanse the bowel and prevent any firm to hard stools
The stools should be made very soft for a few days,
and then need to continue using these medicines with Milk of Magnesia, lactulose etc. till the child is not having any pain while defecation
now she pass well formed stool without blood but few mucus but with crying
A good dietitian consultation would be very important to prevent recurrence, with increased fiber, increased fluid, decreased milk and of course continued gentle stress on toilet training
Need to make the stools softer.... till she stops crying (the fear needs to go and the fissure needs to heal)
Keep a pediatric gastroenterologist in the picture, try to get help with someone working on Pediatric constipation specifically if possible
fissure not seen by sigmoidoscop . lactulose used 3 time daily ,
iam so appreciated for you advices , iam in iraq and i have no such speciality available in my locality
And using the above things... with the basic point of keeping the stool soft for at least 10-15 days continuously till the time the fissure heals
should help treat the child
i will try your adivices what can i do and i will try to contact you again
Try finding the availability of POLYETHYLENE GLYCOL 3350 (or MACROGOL 4000)
There are good studies to suggest that this works well without significant side-effects
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grate thank sir
You are welcome :)
Do get back with further information
dear colleques i have new case can i request new trial