ABSTRACT
An 8-year-old female is referred to your clinic for evaluation of her chronic constipation. She has a history of lifelong stooling problems. She currently has one bowel movement each day and complains of hard stool, abdominal pain, and straining. She has required inpatient hospitalizations twice this past year for a bowel cleanout. She takes the oral osmotic laxative polyethylene glycol 3350 (MiraLAX®) 17 g daily, the oral stimulant laxative senna 65 mg daily and a small volume over-the-counter saline rectal enema as needed. Despite these, she has fecal soiling three to four times a week. She urinates five to six times a day with complete control, but has urinary frequency, urgency, and urinary tract infections three to four times a year. She has been hospitalized once in the past year for pyelonephritis.
