Doc, my baby vomits after every feed and I'm worried

It is normal for babies to spit up some milk when they burp or after a meal.

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Dr Flo,
My 12-week-old boy vomits or spits up after every feed. He has hypospadias. What could be the problem? When should I take him for the surgery?
Confused new mum

Dear confused new mum,
It is normal for babies to spit up some milk when they burp or after a meal. This is because the muscle that closes the junction between the food pipe and the stomach(oesophageal sphincter) is not very strong, but it grows stronger with time and the spit up reduces as the baby grows older. The baby may spit up more if they have been overfed or if they take in a lot of air when they are bottle fed.

You should be concerned if your baby vomits forcefully and removes a lot of milk, or if the vomit has greenish stuff (bile) or blood, if the baby becomes weak or develops difficulty breathing after vomiting, or if the baby is not gaining weight. If any of these is happening, take the baby to a paediatrician.
To reduce the vomiting, make sure the baby’s diaper is not too tight, give smaller and more frequent feeds, feed the baby slowly and hold the baby upright for about 30 minutes after feeding, burp the baby often during and after feeds and do not play with or handle the baby roughly soon after feeds.
Hypospadias is condition where the baby is born with the opening of the urine pipe (urethra) on the underside of the penis rather than at the tip. It develops as the baby is growing in the uterus, probably due to problems with the hormones that influence the baby’s development. It is corrected through surgery, which is done by a paediatric urologist, preferably between six and 12 months of age.

Dr Flo,
I am 18 years old and I got my first period four years ago. In a year, I get my period three or four times. Could that be an issue?

Dear Abby,
For the first two to three years after your periods begin, they tend to be irregular, coming after 21 to 45 days and lasting between two and seven days. By the third year, most girls have regular periods, coming after 20 to 34 days. For some people, the irregularity may take a bit longer to clear. If you stay for longer than three months (90 days) without your periods, you should be reviewed by a gynaecologist because this may be an early indication of a hormonal disorder or other diseases, and the earlier it is detected and treated, the better.

Dr Flo,
I bleed when passing stool, but I am not in pain and I do not have constipation. I have polycystic ovarian syndrome (PCOS). Could this be a side effect? I am not on any medication for PCOS. What could be the problem?

Dear Ash,
The bleeding when you are passing stool is not caused by PCOS. PCOS is a hormonal disorder that affects the menstrual cycle. It can cause problems with ovulation, abnormal uterine bleeding and may lead to problems with fertility and pregnancy, and may be associated with abnormal sugar levels, high cholesterol levels and high blood pressure.

Bleeding after passing stool could be due to a tear in the lining of the anus or rectum, because of friction from passing large stool, hard stool, or from diarrhoea. It could also be due to an abnormal growth in the intestines or rectum. The bleeding could also be due to haemorrhoids, otherwise known as piles. These are veins that bulge in the lower part of the rectum and anus. The walls of the veins stretch and get irritated, and easily get a tear and bleed. They can occur due to straining when passing stool for instance due to constipation or diarrhoea; or any activity that causes repeated high pressure in the abdominal region such as a persistent cough and lifting weights.
You may also get blood in stool if you have a bleeding ulcer, although in this case, the blood is dark and clotted. A gynaecological issue that may cause blood in stool is endometriosis. This occurs when there is uterine lining tissue found in other places other than the uterus. If this tissue is present in the large intestines, the rectum or the anus, then you get bleeding there in response to hormonal changes, same as the bleeding from the uterus.
To manage it, prevent constipation by taking a lot of fluid and a high-fibre diet every day, exercise, schedule time each day for a bowel movement, and take your time; use baby wipes instead of toilet paper and, you can also take a sitz bath (sit in warm water) for about 20 minutes twice a day to help soothe the injured tissue. The doctor can prescribe stool softeners and suppositories to help heal the injured tissue.
You should also see a surgeon, so that an examination can be done to visualise the lining of your anus, rectum and large intestines to see the cause of the bleeding and get the way forward. The PCOS can also be managed by a gynaecologist, depending on your symptoms.

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