I-HUMAN CASE STUDY 4 YEARS OLD
REASON FOR ENCOUNTER: LEAKING STOOL IN
HIS UNDERWEAR
LOCATION: OUTPATIENT CLINIC WITH: X-RAY
ECG LABORATORY CAPABILITIES
, Case Study: Encopresis Due to Chronic Functional
Constipation in a 4-Year-Old
I. Case Overview
• Age: 4 years, 2 months
• Sex: Male
• Race/Ethnicity: Non-Hispanic White (case adaptable)
• Chief Complaint (CC): “My son keeps leaking small amounts of poop in his
underwear every day or two. He doesn’t even seem to notice it.”
• Setting: Outpatient pediatric clinic with on-site X-ray, ECG, and basic laboratory
services (CBC, CMP, TSH, celiac serologies, stool studies).
• Source of History: Mother (primary informant), patient observed during visit.
II. History of Present Illness (HPI)
A. Onset and Duration
Mother reports the problem began approximately 8–10 months ago, initially with her
son passing “very hard, round, dark balls” of stool every 3–4 days. He would cry, hide
behind the couch, and strain for 10–15 minutes. Over the past 5 months, she
noticed small, soft, brownish stains in his underwear almost daily. She thought he was
being “lazy” or “regressing” in toilet training, but recently learned from his preschool
teacher that he “leaks” at school as well and seems unaware.
B. Bowel Pattern Details (Using Bristol Stool Chart)
• Large bowel movements: Occur every 3–4 days; Bristol Type 1 (separate hard
lumps) or Type 2 (lumpy sausage). Described as “golf ball size” or “large as a
plum.” Painful to pass; he sometimes screams or says “owie bottom.”
• In between large BMs: Mother finds small amounts of mushy or liquid
stool (Bristol Type 6) in his underwear, often without any sensation or warning.
This occurs 1–2 times daily.
• Stool color: Normal brown. No blood (denies hematochezia), no mucus, no clay-
colored stool.
REASON FOR ENCOUNTER: LEAKING STOOL IN
HIS UNDERWEAR
LOCATION: OUTPATIENT CLINIC WITH: X-RAY
ECG LABORATORY CAPABILITIES
, Case Study: Encopresis Due to Chronic Functional
Constipation in a 4-Year-Old
I. Case Overview
• Age: 4 years, 2 months
• Sex: Male
• Race/Ethnicity: Non-Hispanic White (case adaptable)
• Chief Complaint (CC): “My son keeps leaking small amounts of poop in his
underwear every day or two. He doesn’t even seem to notice it.”
• Setting: Outpatient pediatric clinic with on-site X-ray, ECG, and basic laboratory
services (CBC, CMP, TSH, celiac serologies, stool studies).
• Source of History: Mother (primary informant), patient observed during visit.
II. History of Present Illness (HPI)
A. Onset and Duration
Mother reports the problem began approximately 8–10 months ago, initially with her
son passing “very hard, round, dark balls” of stool every 3–4 days. He would cry, hide
behind the couch, and strain for 10–15 minutes. Over the past 5 months, she
noticed small, soft, brownish stains in his underwear almost daily. She thought he was
being “lazy” or “regressing” in toilet training, but recently learned from his preschool
teacher that he “leaks” at school as well and seems unaware.
B. Bowel Pattern Details (Using Bristol Stool Chart)
• Large bowel movements: Occur every 3–4 days; Bristol Type 1 (separate hard
lumps) or Type 2 (lumpy sausage). Described as “golf ball size” or “large as a
plum.” Painful to pass; he sometimes screams or says “owie bottom.”
• In between large BMs: Mother finds small amounts of mushy or liquid
stool (Bristol Type 6) in his underwear, often without any sensation or warning.
This occurs 1–2 times daily.
• Stool color: Normal brown. No blood (denies hematochezia), no mucus, no clay-
colored stool.
