When my five-year-old complained that it hurt to pee, I immediately suspected a urinary tract infection and called the doctor. It turned out the reason she hurt “down there” was because she wasn’t wiping properly and the unhygienic results were causing her a great deal of discomfort. I was mortified and ran out to buy bum wipes to help her clean up her act.
Most bottom troubles aren’t commonly discussed in parenting circles. There’s something about “privates” that is, well, private. You don’t want other parents to think you aren’t taking care of your tot’s little tush — and surrounding territory — properly. Lose the guilt, says Michelle Ponti, a paediatrician in London, Ont. “While improper hygiene can sometimes be a factor, it usually has nothing to do with a parent’s care of the child.” We asked Ponti and other health care experts for the bottom line on bottom troubles.
1. Anal fissures
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.
What to do
Fissures heal very well as soon as you treat the constipation, says Henry Ukpeh, an associate clinical professor of paediatrics 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 will help alleviate the pain.
Inflammation of the head and foreskin of the penis is very common in young boys who are uncircumcised. Your son may complain of itchiness and discomfort, and you’ll notice mild swelling, redness and some discharge, particularly under the foreskin. Balanitis is usually caused when the area between the head and foreskin isn’t washed properly, says Michael Weinstein, director of the Paediatric In-patient Unit at Toronto’s Hospital for Sick Children.
What to do
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.” By the time your son is five or six, teach him to retract his own foreskin and clean beneath it once a week when he is having a bath.
3. Labial adhesions
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.
What to do
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.
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. They can also be picked up in the sandbox or on clothes, bedding or toys.
What to do
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. Pinworm infections are treated with an 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.
5. Urinary tract infections
UTIs are twice as common in girls as 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.
What to do
To prevent any damage to the kidneys, your child should see a doctor within 24 hours if she shows signs of a UTI. They clear up quickly with oral antibiotics. In the meantime, give her plenty of fluids to drink (water and cranberry juice are good choices). To prevent further infections, encourage her to go when she has to go and not hold 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 prone to infection from feces and other irritants. “Improper hygiene can be a major factor,” says Ponti. “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.”
What to do
Teach your daughter to wipe from front to back, especially after a bowel movement, so bits of stool don’t end up in the vaginal area, advises Ponti. “You might also want to become more involved with her hygiene after she poops for the first little while.” Moist wipes, such as Candoo Flushable Toilet Wipes, will help her do a better cleanup job. Avoid chemical irritants in bubble baths and heavily scented soaps, and don’t let her sit in a wet bathing suit for too long.
7. Yeast infections
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. 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.
What to do
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.