To: <jack>
Subject: Son with Fissure Update
Date: Fri, 21 Feb 2003 08:43:29 -0800

I wrote to you a few weeks ago about my son (18mo) who I thought was constipated with anal tears. I just wanted to let you know how things are going.

I went to the doctor armed with all of the information I found on the internet and she was glad that I took the initiative to find out causes and treatments for myself. I said I would like to try the Senekot and remove milk from my son's diet for a while. She agreed and she had not heard of the Lansoyl gel, nor had the pharmacist who looked in his book in prescription and non-prescription book.

It took 2 doses and 24 hours for my son to have his first BM which was the largest and hardest I had ever seen. After that ordeal was over, he had two more dirty diapers, not hard at all. We began giving him the Senekot every night and after two days and no BM I began giving him an additional dose in the morning. It was 4 days by the time he had his second BM. I did observe during this time that there were times when his body wanted the BM, but he did not. I could see he was trying to hold it in. At this point, I knew we needed to reinforce him wanting to have a BM. After nearly a week without a bottle of milk, the only thing I could think of that he would really want was milk. I spoke with the doctor and she agreed that if we gave him 6 oz of milk after a BM, I should not cause a problem. After he had his second BM, we gave him milk (we had been trying all week to get him to take soy and/or rice milk, but he would not have it) and he thought it was the "fake" milk and didn't want it. Once he tasted it, you would have thought he was in Heaven. His body completely relaxed and he enjoyed that milk as much as when he was an infant.

I also played a game with him that helped him to continue his BM. Most little kids make faces and noticeably push when they have a BM. I started making faces with him and he would mimic me. After about 7-10 minutes of playing and laughing, my son pushed enough that he couldn't stop. I encouraged him to keep pushing and even though he didn't want to, it all came out fine with no evidence of blood. We gave him milk again, but he was not as interested. We saved it for later, figuring he had earned it.

I decided to wait two days before giving him the medicine again, just so his body was not exposed to so much stimulant. Within 12 hours he had his BM, again still fighting it, but it was soft and there was no evidence of blood. I gave him milk which he was very happy to get and we applauded and told him what a good job he did. We even had his sister come in and clap with us. Any positive reinforcement we can come up with! I waited another 2 days to give him the Senekot and he had his BM 12 hours later with no problems. He is still very scared when he knows it is coming and his is going to have to push. But we have had no constipation. I also should tell you that I have been giving him milk in his cheerios the last several days, but none to drink unless he has a BM. He has also had no cheese, no apples, no applesauce and I have been adding Benefiber to his juice and water to make sure he is getting enough fiber.

What I have learned so far is that he may not have had constipation, but has been holding off on having his BM out of fear of pain. As the other mother suggested, he was not emptying his bowel, so what was left would get very hard. We have a long way to go until I feel he will have BM w/o fear. We are going to begin allowing him to have limited milk to see if any constipation returns. We are going to continue the Senekot for a month, once every 2 days, in hopes of making the BM more of a habit. Once we get him off the laxative, I want to try to reintroduce apples and see if they are constipation factors for him.

I wanted to pass this along in hopes it might help someone else. Thank you for having all of this information available and providing an arena for questions and suggestions.