THE VICIOUS CYCLE OF
WITHHOLDING A PEDIATRIC CASE
STUDY ON ENCOPRESIS
SECONDARY TO CHRONIC
CONSTIPATION EXAM UPDATE
2026
• Name: Master J.B. (Example)
• Age: 4 years old
• Sex: Male
• Date of Birth: 03/15/2020
• Race/Ethnicity: Caucasian
• Source of History: Mother (Primary caretaker), Patient
(observed)
• Reliability: Reliable
History of Present Illness (HPI)
Mother reports that for the past 6-8 months, J.B. has been having
"accidents" where he leaks small amounts of loose, mushy stool
into his underwear without realizing it. She states he is fully potty
trained for urination and usually has a formed bowel movement
(BM) in the toilet every 1-2 days, but between these BMs, she
finds smears of stool in his pants. She denies any diarrheal illness
recently. She reports that J.B. seems to "hold it in" when he has to
, poop, often stiffening his legs or hiding behind the couch. He
occasionally complains of "tummy aches," which are relieved after
a large BM. The leakage is worse in the afternoons after school.
He started preschool 9 months ago, and the mother wonders if he
is afraid to use the school bathroom.
Past Medical History
• Prenatal/Birth: Full-term, spontaneous vaginal delivery. No
complications.
• Feeding History: Breastfed as infant; transitioned to solids
without issue. Current diet consists heavily of white bread,
chicken nuggets, whole milk, and bananas. Low intake of
fruits, vegetables, and water.
• Developmental History: Achieved all milestones
appropriately. Toilet trained for urine at 3.5 years. Initially
trained for stool, but began withholding around age 3.
• Past Illnesses: Occasional upper respiratory infections. No
chronic illnesses.
• Hospitalizations: None.
• Surgery: None.
• Allergies: No known drug or food allergies.
Review of Systems (ROS)
• General: Well-appearing, active. No fever, weight loss, or
fatigue.
• GI: Mother reports "tummy aches" (periumbilical) relieved by
passing a large BM. Reports "leaking" stool. No
WITHHOLDING A PEDIATRIC CASE
STUDY ON ENCOPRESIS
SECONDARY TO CHRONIC
CONSTIPATION EXAM UPDATE
2026
• Name: Master J.B. (Example)
• Age: 4 years old
• Sex: Male
• Date of Birth: 03/15/2020
• Race/Ethnicity: Caucasian
• Source of History: Mother (Primary caretaker), Patient
(observed)
• Reliability: Reliable
History of Present Illness (HPI)
Mother reports that for the past 6-8 months, J.B. has been having
"accidents" where he leaks small amounts of loose, mushy stool
into his underwear without realizing it. She states he is fully potty
trained for urination and usually has a formed bowel movement
(BM) in the toilet every 1-2 days, but between these BMs, she
finds smears of stool in his pants. She denies any diarrheal illness
recently. She reports that J.B. seems to "hold it in" when he has to
, poop, often stiffening his legs or hiding behind the couch. He
occasionally complains of "tummy aches," which are relieved after
a large BM. The leakage is worse in the afternoons after school.
He started preschool 9 months ago, and the mother wonders if he
is afraid to use the school bathroom.
Past Medical History
• Prenatal/Birth: Full-term, spontaneous vaginal delivery. No
complications.
• Feeding History: Breastfed as infant; transitioned to solids
without issue. Current diet consists heavily of white bread,
chicken nuggets, whole milk, and bananas. Low intake of
fruits, vegetables, and water.
• Developmental History: Achieved all milestones
appropriately. Toilet trained for urine at 3.5 years. Initially
trained for stool, but began withholding around age 3.
• Past Illnesses: Occasional upper respiratory infections. No
chronic illnesses.
• Hospitalizations: None.
• Surgery: None.
• Allergies: No known drug or food allergies.
Review of Systems (ROS)
• General: Well-appearing, active. No fever, weight loss, or
fatigue.
• GI: Mother reports "tummy aches" (periumbilical) relieved by
passing a large BM. Reports "leaking" stool. No
