Tenesmus with rectal bleeding...Autoimmune disorder?

[jules35]

My 11 year old son has has ongoing chronic rectal bleeding  during every BMs and directly after.  It is bright red and marroon colored on the stools and in the water.  There is cloudy mucus and blot clots in addition.  His stools are narrow, small, and hard.  Although, with high fiber increases it has become softer but still narrow.  He has tenesmus daily and at time passed only blood and clots.  He has had some constipation, compaction, and straining in the recent past especially in the extreme heat and humidity.  He has avoided BMs at school many times.  He has had some occaisonal brief low grade cramping right before BMs. He has excessive irritability.
No fevers
No diahrea
No know infections
No skin or eye disorders or inflammations
No loss of appetite, nausea or vomiting
No chronic illnesses like the common cold and ear infections, or pneumonia/flu.  Is healthy and seldom ill at all.
No abdominal swelling or pains
No signs of malabsorption with normal growth and weight, and good muscle tone with normal energy levels
No signs of anemia with blood tests
No waking up at night to use the toilet for BMs or because of cramping


He has been examined.  He has had blood and stool tests, a colonoscopy with bioposy.  There have been no finding to suggest anything other than inflammation and colitis at this time.  It has been hard to find any pediactric gastroenterologists in our area of geriactrics and the retired.  There is only one and he is not that experienced and sometimes not available and too buisy to answer all my questions.

What specific diagnostic test(s) would be the best to do next at this point with the symptoms invasive or noninvasive?
What would you suggest?
.

[CalGal]

Jules, get copies of ALL the written reports - the doc's exam report during the colonoscopy and the biopsy report. Read through them, and if necessary, post the pertinent details. Someone here should be able to give you a hand to understand what's written in those reports.

[dorr77]

you do not mention where you live--if in an area known to your friends online at med health know--perhaps ya would be assisted with a helpful hint with a satisfied patient or parent to let you in on a better caring doc...ya think? until then, good luck. (in atl area, i know some good places for seizure disorders for kids, there is the big cdc locally for those w/cancer prognosis...maybe you should let that transpire?)

[jules35]

Thanks for the detailed info and it helped a lot.  I wish the doctor was more informative and could thoroughly explain things to us.  I had to learn what I could over the cluttered internet.  The doctor has a strong accent, is vague and rushes us in and out of his buisy office.

[CalGal]

I would assume the doc took a biopsy, so the pathology report should have given him some idea of what might be going on. It would have told him if there were infiltrations of cells into certain layers of the tissues, etc. If the doc suspects some form of IBD, a biopsy would tell if it was either lymphocytic or collagenous colitis. And since inflammation is present, he could also do a test like the Serology 7 blood test that will give some indication (possibly) if your son has 'markers' that indicate the presence of either Crohn's or U.C.

If your doctor didn't take biopsies, I would suggest that you find another doctor to work with. A doc shouldn't 'assume' your son might have Crohn's because of the presence of inflammation and the urge to have a bowel movement.

[jules35]

Colitis is inflammation of the colon ( itis = inflammation)?.  Well, the doctor was not sure when he simply suggested colitis.  He has inflammation, swelling and bleeding in the colon but no ulcerations were found in the colonoscopy.  He did mention the possibility of Chron's because of the fact that he has the constant urge for bowl movements.  My son has had no pain and absolutely no diarrhea and is very healthy besides the ongoing  problem he has with his lower bowls.   There seems to be no indicators of anything specific.

[CalGal]

Inflammation and colitis? What form of colitis was he diagnosed with? Colitis is a term that is used to denote forms of inflammatory bowel conditions: Crohn's, Crohn's colitis, ulcerative colitis, non-specific and microscopic colitis.

[Morecambe]

Personally I cannot offer any advice - but I do think that your question is sufficiently complex such that you may receive more meaningful and knowledgeable suggestions by reposting it on Dr Pho's "expert/ask a doctor" gastro site.  He may also be able to refer you to a specific hospital/specialist where the high level of expertise that you seek is available.

Good luck
Morecambe