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Children's Health

Never had a formed stool at 3

03/27/2009

Question:

Hi. My question below was answered with a link to another similar question. Thank you.

I need some more help please. My son has never had a formed stool and he`s 3. He`s never been toliet trained. And he mentions abdominal pain with bowel movements. No major (or minor) stressors in our lives, just life as normal. Any other suggestions?

Thank you

Original question:

My son is 3 and he has never had a formed stool. He has up to 5 mushy stools a day. There are days when he just oozes stool. He has told me having bowel movements hurt, and when asked where he points to the umbilicus area. He won`t even conisder having a bowel movement on the toliet, as he doesn`t like stool on his skin, but it`s so mushy that`s where it winds up. Other than that, he is an active boy, growing well and good weight gain. He has excema and a familial history of food allergies. His diet is excellent.

Is this normal? He was a prem (34 weeks) and had feeding and respiratory issues at birth.

Thanks!

Answer:

I am thinking that perhaps it seemed from your prior question that your son might have constipation (dry, hard stool that is difficult to pass) as a cause of his abdominal pain. That is very common in children his age and the major trigger for holding stool in and the stool becoming hard, dry and painful to pass. Children can have soft or even liquid stool leak around the dry, hard stool mass and appear not to have constipation. This is called encopresis and is also very common in his age group.

Another common cause of painful stooling is having an internal fissure or hemorrhoid in the rectum or an external fissure at the anus. External fissure appear as dark pink and moist streaks radiating from the anal opening. External fissures respond well to soaking in the bath tub and the application of vitamin A & D ointment. Internal fissures and hemorrhoids do heal but are best managed by a specialist.

If you have not discussed the problem with your son's doctor, it would be a good idea to do so. If you have to wait a few days for an appointment, keep a food and drink diary and stooling diary to bring with you to give the doctor a good idea of his daily diet and stooling patterns. If you have exhausted his doctor's ideas for solving the problem, you can request a referral to a pediatric gastroenterologist (GI) specialist.

I hope these ideas are helpful as you try to help your son be more comfortable.

For more information:

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University