ABSTRACT
For each of the following children with constipation, select the next most appropriate step in management. Each option may be used once, more than once or not at all.
1. A 12-year-old boy is constipated. He opens his bowels on average once each week. He describes this as being incredibly painful, ‘like a tearing pain’. On wiping, he has noticed blood on the toilet paper. Examination is very painful, and a skin tag is present at the anal verge.
