Trouble Down There: 7 Common Reasons For Your Kid's Discomfort

If your child cries every time she has a bowel movement and you notice streaks of blood on her stools, there’s a good chance she has a small tear known as an anal fissure—especially if her stools are hard. When children become constipated, they may strain to push the stool out and tear the skin around the anus. The tear, or fissure, can easily be seen when you examine your child’s behind.

Fissures heal very well as soon as you treat constipation, says Henry Ukpeh, an associate clinical professor of pediatrics at BC Children’s Hospital. Ask the doctor to recommend a stool softener, and add more fluids (especially water) and fibre to your child’s diet. Applying petroleum jelly to the sore spot can help alleviate the pain. AboutKidsHealth notes that anal fissures in children are commonly linked to constipation, so treatment usually focuses on softening stools, increasing fluids and helping the tear heal.

Balanitis can be linked to irritation, trapped moisture, or bacterial or fungal overgrowth—and in some cases, hygiene plays a role too, says Michael Weinstein, director of the Paediatric In-patient Unit at Toronto’s Hospital for Sick Children. Your son may complain of itchiness and discomfort, and you’ll notice mild swelling, redness and some discharge, particularly under the foreskin.

Proper hygiene and a topical antibiotic or antifungal usually take care of this plumbing problem. “Sometimes we have to counsel parents on how to clean that area properly,” says Weinstein. “They have the misconception that you should be able to retract the foreskin and clean under it, but the foreskin in young boys doesn’t retract. All that’s required is gentle cleaning around the outside of the foreskin with soap and water.” Caring for Kids and AboutKidsHealth advise that the foreskin should never be forced back; once it separates naturally, boys can be taught how to gently clean underneath.

If the skin of your daughter’s genitals appears to be stuck together, don’t panic. Even though the condition looks worrisome, it’s quite common in young girls between the ages of three months and six years, and rarely causes problems. Urine, stool, diaper rash and other irritants can all cause inflammation of the labia (the lips of skin surrounding the entrance to the vagina).

The lips may fuse together as they heal and partially cover the opening of the vagina. “Labial adhesions are only a concern if the labia are so fused together that your daughter has trouble peeing,” says Ukpeh.

Never try to separate the labia forcefully. If the adhesions are blocking the flow of urine, your doctor may prescribe a topical estrogen cream. To prevent new adhesions, use a lubricant, such as Vaseline, on a daily basis. Try to avoid irritants (bubble baths, fabric softeners, perfumed soaps), and give your child some bare bum time every day. According to AboutKidsHealth, many labial adhesions clear up on their own and usually only need treatment if they’re causing symptoms such as urinary problems or repeated infections.

While these tiny, white, thread-like worms are mostly a nuisance, they still make parents shudder—and children itch. Pinworms spread easily when an infected child scratches the itchy area (usually the anus, but girls may have an itchy vulva too) and gets pinworm eggs on her fingers or under her fingernails.

These gross worms can also be picked up in the sandbox or on clothes, bedding, or even kids' mattresses or toys. If you find pinworms in your baby's diaper, it's important to call your physician.

If your child complains at night of an itchy bum, pull out your flashlight and see if you can spot any coming out of her bottom after she’s gone to sleep. You can also press a piece of transparent adhesive tape on the skin around her anus in the morning before she gets up, and have the doctor check it for pinworms and their eggs. This is called a tape test and is fairly routine—and yes, you can do it at home.

For the tape test instructions, the CDC’s diagnosis guidance says it works best first thing in the morning, before your child bathes, uses the toilet or gets dressed. Caring for Kids notes that pinworms are a common childhood infection that often causes intense nighttime itching, and treatment usually involves medication plus careful hygiene to prevent reinfection.

Pinworm infections are treated with oral antiparasitic medicine. Sometimes the entire family needs to be treated. To prevent reinfection, make sure everyone washes their hands thoroughly after going to the bathroom, keep fingernails short and wash clothes and bedding regularly.

UTIs are twice as common in girls as in boys simply because of female anatomy. Pain while peeing is a big red flag for this bottom trouble. Other telltale UTI signs include more frequent urination but just a dribble of pee, foul-smelling or cloudy urine, and sometimes fever. It’s difficult to diagnose a bladder infection in toddlers because they may not complain that it burns when they pee, says Ukpeh. Sometimes fever and irritability are the only symptoms.

To help prevent complications, your child should see a doctor promptly if she shows signs of a UTI. A urine test is usually needed to confirm the infection, and UTIs are typically treated with antibiotics when bacteria are the cause. In the meantime, offer fluids to help keep your child hydrated. If you want to mention cranberry products, frame them carefully: they are not a treatment for an active UTI, though some families ask about them as a possible prevention strategy. To help lower the risk of future infections, encourage your child to pee when she needs to go instead of holding it.

Redness, discomfort and itching of the outer part of the vagina (the vulva) is common in young girls. The lining of the vulva tends to be thin and easily irritated in young girls. Stool, dampness, bubble baths, scented soaps, tight clothing and bits of toilet paper can all contribute, and hygiene can be one factor too. “Four- and five-year-old girls are independent in the bathroom for the most part, and they’ll either not wipe properly or not wipe at all because they’re in such a hurry to get back to their playing,” says Ponti.

Teach your daughter to wipe from front to back, especially after a bowel movement, but remember that wiping is only one piece of prevention. It also helps to avoid bubble baths and heavily scented soaps, change out of wet bathing suits promptly and keep the area clean and dry.

“You might also want to become more involved with her hygiene after she poops for the first little while.” Avoid chemical irritants in bubble baths and heavily scented soaps, and don’t let her sit in a wet bathing suit for too long.

If your baby has a diaper rash that persists despite your best efforts to treat it, yeast may be to blame. Both girls and boys can get a yeast diaper rash caused by Candida albicans, says Weinstein. The angry red rash has slightly raised borders, and satellite lesions (red spots a slight distance from the main rash), and the skin may be scaly. It can be bothersome when little butts hit the toilet seat, too.

A diaper rash that is left untreated can easily become infected with yeast, and children on antibiotics or who have recently had thrush (a yeast infection of the mouth) are also more susceptible.

Diaper rash creams won’t cure a yeast infection; you need to apply an anti-yeast or antifungal cream, such as nystatin, clotrimazole or miconazole. Try to limit moisture by changing your baby’s diaper frequently and using highly absorbent disposable diapers. And try to let your little one’s bottom air-dry whenever possible. Caring for Kids notes that yeast diaper rashes are often bright red with defined borders or small surrounding spots, and they’re typically treated with antifungal cream plus efforts to keep the area clean and dry.

Call your doctor now if:

• Your child has a fever
• Is in significant pain
• Can’t pee
• Has blood in the urine
• Has swelling that’s getting worse
• Seems very unwell
• Is an infant with symptoms that could point to an infection

Book an appointment soon if:

• Symptoms aren’t improving after home care
• The problem keeps coming back
• Your child has pain when peeing
• You suspect a UTI
• The irritation is making it hard for your child to sleep, poop or go about their day

Try home care first if:

The irritation seems mild, and your child is otherwise well. Depending on the cause, that may mean adding fluids and fibre for constipation, avoiding scented soaps or bubble baths, changing out of wet clothing quickly, keeping the area clean and dry, or following your doctor’s advice for antifungal or other treatment.