Case Study Part III - Epilogue

A little boy riding his toy car

You are concerned about the history of constipation and ask Jack’s mother a few more questions while you perform the physical exam.

  • Has he had any diarrhea (i.e., overflow leakage of stool associated with constipation)?
  • Is there blood in the stools?
  • Can she tell or can Jack communicate whether he experiences pain with the bowel movements?
  • What has she tried to help constipation?

He has not had any recent diarrhea or blood in his stools. She is unsure whether he is having pain with bowel movements because he goes in his diapers. She thought the fruit juice would help, so she lets him have it whenever he asks.

A little boy with face paint

Your abdominal physical exam is normal, although Jack was slightly uncooperative. You decide to defer the rectal exam.You give Jack a stool softener and ask his mother to stop toilet training at this time. You schedule a follow-up appointment so you can devote more time to discussing Jack’s diet, toileting issues, and sleep. You also refer him to a otolaryngologist clinic for evaluation of possible sleep apnea.

8 of 10