instruction: hi doctor I have an 18 month old daughter my daughter has had trouble with her bowels since she was months old she finds it impossible to do a normal stool she strains and screams to the point she falls asleep from exhaustion and still does not pass stool she does have a regular bowel movement but she is in constant pain while doing it her stool has got to the point of having blood in it I have taken her to numerous doctors and tried just about everything possible to help her current specialist has given her the same medicine which I have stated does not work it does not matter what the dosage is I have contacted him to tell him it does not work and he has just said to change her to another type of laxative laxatives do not work for her I feel it is something more serious so I was just wondering if you could take the time out to give me some advice on what I could do or what might be wrong with my daughter I cannot handle watching her be in pain anymore
output: hi she has chronic constipation as you have noticed blood she also may have fissure in anus due to which she has extreme pain give her lots of water and a high fiber diet dry fig milkshake dates and prunes in any form help a lot give either one of them every day along with fruits and vegetables you can try lactulose suppository for a few days which may prove more effective than syearup secondly make her sit in a tub of lukewarm water with few drops of salon put on it this is called a sit bath which will help if there is fissure wound due to peeling of skin in the anal area do this three times a day also encourage her to pass stools immediately after every meal as it is the ideal time to try when bowels are in action for the digestion of food if you do not find any improvement in five to seven days please consult a pediatric surgeon to check the fissure and investigate further