THE SILENT OVERFLOW A CASE
OF CHRONIC CONSTIPATION
PRESENTING AS FECAL
INCONTINENCE IN A 4-YEAR-
OLD
Patient Initials: J.D.
Age: 4 Years 2 Months
Gender: Male
Date of Visit: October 26, 2023
SUBJECTIVE (S)
Chief Complaint (CC): "He keeps leaking poop in his underwear.
It's like he doesn't even know it's happening." (Mother's
statement).
History of Present Illness (HPI):
Mother reports a 6-8 month history of J.D. passing small amounts
of loose, mushy stool into his underwear on a near-daily basis.
She describes this as "staining" or "leaking" rather than a full
bowel movement. He is reportedly unaware of these episodes and
does not complain of discomfort when they occur. J.D. has full-
, blown, formed bowel movements in the toilet only once or twice a
week, which are described as "very large" and "hard," sometimes
clogging the toilet. He occasionally complains of stomach aches,
which are relieved after these large BMs. Toilet training for bowel
movements was completed around age 3, but these episodes
began a few months later. Mother has tried restricting certain
foods and has asked J.D. to "try harder," with no success.
Past Medical History:
• Prenatal/Birth History: Full-term, uncomplicated vaginal
delivery.
• Medical History: Healthy child. No chronic illnesses.
Occasional upper respiratory infections.
• Surgical History: None.
• Injuries: None.
Medications:
• None currently. Occasional acetaminophen for fever or pain.
Allergies:
• No known drug, food, or environmental allergies.
Immunizations:
• Up to date according to the CDC schedule for a 4-year-old.
Family History:
• Mother: 32, healthy.
• Father: 35, healthy.
• Sibling: 6-year-old sister, healthy.
OF CHRONIC CONSTIPATION
PRESENTING AS FECAL
INCONTINENCE IN A 4-YEAR-
OLD
Patient Initials: J.D.
Age: 4 Years 2 Months
Gender: Male
Date of Visit: October 26, 2023
SUBJECTIVE (S)
Chief Complaint (CC): "He keeps leaking poop in his underwear.
It's like he doesn't even know it's happening." (Mother's
statement).
History of Present Illness (HPI):
Mother reports a 6-8 month history of J.D. passing small amounts
of loose, mushy stool into his underwear on a near-daily basis.
She describes this as "staining" or "leaking" rather than a full
bowel movement. He is reportedly unaware of these episodes and
does not complain of discomfort when they occur. J.D. has full-
, blown, formed bowel movements in the toilet only once or twice a
week, which are described as "very large" and "hard," sometimes
clogging the toilet. He occasionally complains of stomach aches,
which are relieved after these large BMs. Toilet training for bowel
movements was completed around age 3, but these episodes
began a few months later. Mother has tried restricting certain
foods and has asked J.D. to "try harder," with no success.
Past Medical History:
• Prenatal/Birth History: Full-term, uncomplicated vaginal
delivery.
• Medical History: Healthy child. No chronic illnesses.
Occasional upper respiratory infections.
• Surgical History: None.
• Injuries: None.
Medications:
• None currently. Occasional acetaminophen for fever or pain.
Allergies:
• No known drug, food, or environmental allergies.
Immunizations:
• Up to date according to the CDC schedule for a 4-year-old.
Family History:
• Mother: 32, healthy.
• Father: 35, healthy.
• Sibling: 6-year-old sister, healthy.
