The pain has likely returned because ongoing constipation is reopening the healing tear. Since you are already using Fidonal and Duphalac (lactulose), the next step is to focus on keeping your stools very soft. Try significantly increasing your daily water intake and eating more fiber-rich foods. Taking warm baths (sitz baths) for 15 minutes after bowel movements can also greatly relieve pain and help the muscle relax. Please consult your doctor to discuss adjusting your Duphalac dose or exploring other gentle stool softeners if your symptoms persist.

The green fluid and suspected strictures point to a physical narrowing in her intestines, which explains her feeding difficulties. While lactulose (Duphalac) can sometimes cause gas, the main issue is this narrowing. Surgery is often the safest and most effective path to repair these strictures, allowing her digestive tract to heal so she can feed comfortably and grow stronger. Please trust her neonatal team and ask them to walk you through the surgical plan step-by-step. They are highly specialized in helping brave little ones through these exact challenges.

For her severe diarrhea, please temporarily stop Duphalac (lactulose) and focus on hydration. Since she recently had gentamicin, her doctor should evaluate her diarrhea to rule out antibiotic-related issues. For her persistent UTI and burning, a repeat urine culture is essential to select a targeted antibiotic, as the E. coli may be resistant to previous treatments. Continue using the Evalon (estriol) cream, which helps strengthen local defenses.

Regarding prucalopride, there is very limited safety data during pregnancy, so it is generally recommended to avoid it while trying to conceive and during pregnancy. Since Cremaffin and Duphalac haven't worked for you, safer alternatives during pregnancy include bulk-forming laxatives like psyllium, or macrogol (polyethylene glycol) laxatives, which are safe for the baby. Please consult your obstetrician or gastroenterologist to safely adjust your treatment plan before conceiving.

Six days without a bowel movement, even while taking Duphalac (lactulose), means it is best to contact your pediatrician. They can safely adjust the lactulose dose or recommend a gentle alternative. In the meantime, ensure she stays hydrated with plenty of water or a little diluted prune or pear juice, and try gentle tummy massages. Please avoid starting any new treatments or suppositories without consulting her doctor first.

Since you are experiencing slow movement and incomplete emptying, it is important to consult a gastroenterologist. They can perform diagnostic tests, like anorectal manometry, to check your pelvic floor muscles. A highly effective, non-invasive treatment called biofeedback therapy can help retrain these muscles to empty fully. Your doctor may also discuss alternative prescription options, such as lubiprostone or linaclotide. Please be reassured that we have many avenues left to explore to help you feel comfortable again.