02-26-2007, 05:45 PM
A 6-year-old boy who is in first grade is brought to your clinic because his parents are quite upset about his encopresis. The patient had been successfully toilet trained at 3 years of age, but the mother reports the boy now goes several days without having a bowel movement. His stools are so large in size that there is pain with bowel movements. About three times a week, the patient has loose stool that leaks into his underwear. This is causing great problems with teasing at school. On physical exam, you find a large amount of stool in the rectum. The best next step in the management of this patient is:
A. Institute a low-fiber diet
B. Prescribe enemas or laxatives to evacuate retained stool
C. Have child sit on toilet for at least 30 minutes (or until bowel movement] daily
D. Order a barium enema
E. Refer patient to a child psychiatrist
A. Institute a low-fiber diet
B. Prescribe enemas or laxatives to evacuate retained stool
C. Have child sit on toilet for at least 30 minutes (or until bowel movement] daily
D. Order a barium enema
E. Refer patient to a child psychiatrist