ABSTRACT
A 9-year-old patient with a 7-year history of severe functional constipation with soiling presents for evaluation. He participated in a bowel management program after several years of minimal success on multiple laxative-based regimens. Physical examination revealed an abdomen that was softly distended and a normal-sized and well-positioned anus. His work-up included a contrast enema, which showed that the child had a moderately dilated rectosigmoid colon. Because he failed medical management he underwent motility evaluation which included anal manometry (AMAN), colonic manometry (CMAN), and a rectal biopsy. All of these studies were completely normal. The child was placed on rectal enemas with a regimen of 400 mL of Saline and 20 mL of glycerin, because laxatives had been ineffective. These improved his emptying dramatically and resolved his soiling, but the enemas were traumatic and he became anally defensive. The patient is continent of urine and has no underlying urinary dysfunction or renal disease.
