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Doctor at the Desk

Wiggle with It

Mommy, what's that thing wiggling in my bottom?
By: Lourdes Nena A. Cabison-Carlos, MD article_5

“Mommy, what’s that thing wiggling in my bottom?” A common question by mothers during check-ups is how they can know if their child has a worm infestation. Understandably, parents will be concerned whether their child has an unwanted tenant on their tummy. While knowing that your little one has worm infestation can be upsetting, treatment is relatively easy to administer. However, reinfestation is common especially if sanitation and hygiene are poor. 

Where do worms “live”?                               

Worms are parasites that can often reside inside the body. Roundworms (Ascaris sp), hookworms (Ancyclostoma spp and Necator americanus), whipworms (Trichuris sp), tapeworms (Taenia spp) and pinworms (Enterobius) are only a few of the more common kinds of worm that can invade the body.

How do we get them?

There are a lot of mechanisms on how we get infected. The Philippines have a relatively high prevalence of soil-transmitted parasites. Approximately 81 provinces in our country are affected. Dirty flood water can also be a vector for infection.

  • Soil: This is one of the more common modes of transmitting worms. Damp, dirty soil, especially those that contain human and animal feces have a high likelihood of harboring worm eggs.
  • Water: Parasites can live almost anywhere, and dirty water guarantees the presence of numerous Mr. Bacterias and Ms. Parasites. Puddles, dams, lakes and (wet) rice paddies are favourite breeding places for parasites.
  • Undercooked or infected food: Unwashed or improperly prepared vegetables and fruits can carry numerous parasite eggs, especially those which were grown in areas near dirty water or                     sewage systems. 
  • Contact with an infected person: Believe it or not, worm eggs can be transmitted in the fingernails of an infected person who did not wash hands after scratching his butt.
  • Auto-infection: As if being infected is not enough, you can auto-infect yourself by habitually putting your fingers (which can contain worm eggs) inside your mouth. This is especially true for kids who thumb suck.

What are the symptoms of worm (parasite) infection?

Most of the time, children who have parasites are asymptomatic, unless the parasite burden gets high (meaning, there is a very large number of worms). However, some children may present with the following:

  • Anemia and iron deficiency: This is due to chronic intestinal blood loss. Moderate to heavy infection particularly of hookworms can cause iron deficiency anemia which can affect growth and intellectual development of children.
  • Malnutrition: As with iron deficiency anemia, malnutrition is caused by intestinal blood loss combined with poor nutrient absorption and sometimes, poor appetite.
  • Vague abdominal pain, loss of appetite and diarrhea: These non-specific symptoms can often clue you in to a possible intestinal infection.
  • Itchiness in the perianal area: This is a common symptom of pinworm infection and is more prominent during night time. The itchiness can lead to poor sleep quality and restlessness.
  • Cough (with or without blood): This may sound so morbid, but I kid you not: some children (even adults) can harbor parasites in the lungs, which can lead to a cough and other respiratory symptoms. A few individuals even have reported coughing out worms.
  • Rash: This is caused by substances released by the parasites, which then lead to allergic reactions in some individuals.
  • Intestinal blockage, vomiting or passing out worms: These can result especially when there is a large population of parasites present.

These are just a few of the symptoms of intestinal parasitism. If you’re not yet too disgusted, let’s move on (we are done with the gross stuff, I promise).

How do you diagnose worm infection?

Most of the time, your doctor can make a presumptive diagnosis based on a thorough history and physical examination. Some tests can be done to identify the parasite and definitively establish infection such as:

  • Stool examination
  • Tape test (a very sophisticated method of putting adhesive tape on the rectal area to obtain parasite eggs) or cotton swab test
  • Examination of intestinal fluid to demonstrate larvae
  • Blood tests which can demonstrate anemia and changes in white blood cell counts, etc.
  • Biopsy for parasites that invades the body tissues

Treatment for worm infection or intestinal parasitism is relatively easy. Most can be treated with oral medications. Usually, your doctor will prescribe a medicine depending on the type of parasite your child has. As for herbal remedies, there are no definite studies that prove their effectiveness so it is prudent to talk with your doctor about the best treatment options.

The number one key to prevention is good personal hygiene. It is best to start teaching children about proper hand washing and cleanliness at a young age. Teach them to use slippers or shoes when walking and playing in the yard. As a community, we can also push for improvement of sanitation and provision of clean water to all. Since this is resource-limited, we can do our part in helping build latrines in depressed areas, distributing shoes/ slippers and educating the community on the importance of good personal hygiene. By these simple measures, we can hopefully aim for a 100% wiggle-free bottom!


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Keywords: malnutrition, anemia, worm, stool, parasite, parenting   
  
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