How can we investigate cause of kid's gassy poop while waiting for MD?

April 3, 2017 3:07 PM

We're talking radioactive ammonia stink and a toilet bowl that looks like an explosion, every single time he goes. Smelly, gassy, poopy details inside (click at your own risk!)

Short version:
When kid poops, he passes a lot of gas. No diarrhea; no abnormal blood/stool results; rarely reports abdominal pain; no flatulence; little lactose in diet; lots of sugar in diet
What investigation can we do while waiting to see doctor again? Should we consider the possibility that this is "normal" functioning of his colon?

Long version:
Our kid has been in our lives for about a year now (he's 8, we adopted him 1 year ago), and we don't have much info on his medical history.

When he poops - he releases a ton of gas at the same time; while it sounds as if he has diarrhea (it's loud and explosive-sounding), his stool are actually semi-solid to solid. There's a an ammonia smell from time to time.

We've done 2 blood tests and 2 stool tests; the first set found a bit of giardia; the second was clear. While our pediatrician seems to focus on blood test results, we're haven't really insisted on further testing, primarily because our kid is terrified of needles and if we aren't cautious in our approach I fear we'll exacerbate his phobia.

Kid's diet has very little lactose, but is higher in sugar that it should be.

The only time he complains about stomach pain is if he has to go, but holds it in (for example, he doesn't like going in school, so he'll hold it in all day, sometimes). But he doesn't report bloating or pain typically.

He used to fart a lot before, but since the giardia was treated, he doesn't really do that either.

Then again, maybe this is just a variation in the human pooping mechanism? When I'm in a public bathroom stall, I sometimes will get a neighbour who tries to woo me with a brass- and woodwind serenade.

So what say you internet strangers who are not my child's pediatrician? What should be our next course of action? I'm thinking about finding a new pediatrician, but in the meantime, what investigations should we do?

thanks!

posted by anonymous to Health & Fitness (11 answers total)

This is what sharing a bathroom with my roommate was like before he was diagnosed with actual real celiac's disease.
posted by crush at 3:22 PM on April 3, 2017 [4 favorites]

How long has it been since the treatment for giardia? (Antibiotics, yes?) I ask because sometimes it can take quite a while for the gut's bacteria to normalize after that, which can lead to lots of gas. (And by quite a while, I mean it can take 6+ months!)

But it sounds like he doesn't have lots of gas aside from when he goes to the bathroom? Maybe he just doesn't feel comfortable enough yet around you (even subconsciously) to let his farts rip when he's not in the bathroom?

Your short version makes this situation sound more serious than the long version which is kinda confusing me.

Edited to add, I'm not making up the unhappy guts post-infection thing. Post-infectious IBS is a thing that can happen and people do recover from it.
posted by purple_bird at 4:27 PM on April 3, 2017 [1 favorite]

My doctor recommended probiotics when I was having some digestive trouble after a course of antibiotics. I was skeptical, but they made a huge difference. She said to get ones that require refrigeration, have at least three different strains, and have at least 10? (Maybe 5? I don't remember.) CFU. I ended up with some Solaray ones that were one of the cheaper options from Whole Foods.

My symptoms were different than your kid's symptoms, but my understanding is that probiotics are generally in the harmless to helpful spectrum, so it might be worth trying if your pediatrician okays it.
posted by insectosaurus at 5:19 PM on April 3, 2017 [3 favorites]

Have you tried probiotics? I agree you need medical expertise but it may help, esp if he never had them after the giardia and antibiotics. I doubt it will hurt in any case.
posted by john_snow at 5:21 PM on April 3, 2017 [1 favorite]

Hiya, I'm an epidemiologist but also have Crohn's, so I'm saying this from a professional and personal slant: this could be a lot of things, many benign. So you shouldn't worry unless his self-reported pain and comfort levels change in a bad direction. At the simplest end of things, time might be on your side--treatment with aggressive antibiotics (which he probably received for giardia) may have knocked out his usual gut flora, and that takes time (and a regular diet) to amend. If this is bacterial overgrowth, you'll probably be advised to cut down on the sugar (which is more or less unadulterated bacteria food) and increase fiber intake via fruits and vegetables.

Given his age, I wouldn't rush in to using a commercial over-the-counter probiotic. Yogurt and bacterially fermented/cultured foods should be fine, but don't opt for the kinds of probiotics that are marketed as medicines (those things aren't standardized or evaluated for efficacy or safety or even identity in the U.S., companies making them just voluntarily report what consumers assume is accurate information about what's in the product).

I'd be totally comfortable asking my pediatrician for a gastroenterologist recommendation. There's probably some merit in a specialist's insights, which (I'm sorry to say) may come with some poking and prodding, like a lower GI ultrasound or endoscopy, after they review the medical records you already have. It's an unpleasant necessity, if for no other reason than to establish a baseline (since his medical records only go back a year, it seems) to compare future issues against.

Be well! Congratulations on your adoption!
posted by late afternoon dreaming hotel at 7:27 PM on April 3, 2017 [5 favorites]

While (and after) he recovered from an infection, my son filled some of the foulest diapers I have ever seen/smelled. We did a bunch of stool samples and labs that turned up nothing. Our pediatrician was of the opinion that his gut's bacteria needed to repopulate, so we gave him a powdered probiotic and yogurt at mealtimes to help it along. I would try that first as a less-invasive option.
posted by pepper bird at 4:25 AM on April 4, 2017

You may find it helpful to keep a food diary for his food intake. Sometimes when you see it on paper the culprit is obvious. Or, at least, it makes doing an elimination (no pun intended!) diet easier.

When you say sugar, are you talking about actual sweets like cookies, fruit roll-ups, that sort of thing, or are you talking about natural sugars like a ton of fruit? Is there a particular fruit that he eats a lot of?

If it is truly sweets, maybe balance out his sugar situation with more probiotic and prebiotic types of fruits. It's a good time of year for all kinds of berries.

Curious as to why the diet is lactose-free? Is that in initial response to the gassiness? Maybe lactose was never the culprit. What is replacing dairy in his diet? Is it almond milk, hemp milk? Processed milks might not be working well for him.

Nthing trying to go gluten-free. It seems overwhelming at first but the truly gf folks can offer lots of options. In our house (we are not truly gf but lean that way) we do tacos with corn tortillas, stir-fry's, fried rice (throw in eggs for protein and some veg), stews, or just meat, steamed veg, and rice. We do a gluten free lunch for our kiddo by doing a homemade "lunchable", with cut up lunchmeats, slices of cheese, and some nutcrunch snacks.

Sorry that your little guy is going through this, it must be awful for all of you and it sounds like it is affecting him at school. I hope he is feeling better soon.
posted by vignettist at 8:58 AM on April 4, 2017

Also be sure your MD checks for intestinal parasites: tapeworm, ringworm, pinworm, etc.
posted by cyclicker at 10:02 AM on April 4, 2017

Yep, watch the sugars. Especially processed sugar. Also a good yogurt with help with gut bacteria.
posted by PJMoore at 11:21 AM on April 4, 2017

I would also try to test a few charcoal tablets (one a day) just to see if they help with the wind (& they won't hurt) but it does sound coeliac....
posted by Wilder at 11:51 AM on April 4, 2017

From the anonymous OP:

Thanks a lot! to all of you - I really appreciate your tips, insight, and wishes!

posted by LobsterMitten at 3:04 PM on April 4, 2017