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case study cc;leaking stool Content; HPI
STATEMENT,HISTORY,PHYSICALEXAM
2025/2026
,Version1and2
Maxkingsi-humancasestudycc;leakingstool
Content;HPISTATEMENT,HISTORY,PHYSICALEXAM,TESTING,DIFFERENTIALDIAGNOSIS,
SUMMARY,PLANFORPATIENT,EXERCISES,EXPERTFEEDBACK,CASESUMMARY
,Version1and2
Maxkingsi-humancasestudycc;leakingstool
HPI
Max King is a 4-years Old Caucasian male child visited the clinic with his father with a
complaintofleakingstoolsinhisunderwear forthepast3-weeks.Fatherstatesthathischildhad
intermittentabdominalpainfor2yearsandhadexperiencedhardstoolsaswell.Healsoreported that his
child started having watering stools, 2-3 times in a day for the past 3-weeks. He went further to
explained that the abdominal pain usually starts after eating and gets better a few minutes.
According to max’s father, he states that his son is picky eater, and do not eat vegetables or
healthy.Maxisknowntoloveeatingfriedfoodanddessert,drinkthreecupsofmilksinaday, and do not
drink enough water.
Thefathermentionedthatmaxispottytrained,andhedeniesnauseaorvomiting,fever,bleeding with
defecation, and headache. He reported of straining when defecating.
Physicalexaminationrevealedadiffusetendernesstopalpationoftheabdomen.
Treatment/ManagementPlan
PrimaryDiagnosis:EncopresisandICD-10code:F98.1
• Encopresis sometimes called stool soiling can been defined as an intentional or
involuntarymovementofstoolsintotheunderwearorclothing.Itusuallyoccursintoilet
trainedchildrenwithdevelopmentalagethatisgreaterorequalsto4 years.Thechild usual resist
defecation which causes feces to be impacted in the colon leading to constipation, and
later followed by leaking watery stool (Colombo et al., 2017).
In most cases, it happens because a child has a chronic constipation. Some of the
symptomsincludetheneedtohaveabowelmovementwithlittleornowarning,loseor watery
stool, leakage of stool into the underwear, intermittent abdominal pain, constipation,
avoiding defecation, and urinary tract infections.
In this case Max has all the symptoms of encopresis, and both the subjective and
objectivedatasupportedthediagnosiswiththeabdominalx-raythatshowedimpacted large
stools in the colon.
DifferentialDiagnosis
• Celiac disease – K90.0: This is a genetic autoimmune reaction to eating gluten, a
proteinfound in wheat, barley, and rye, which can affect the gut, and other organs
(WoltersKluwerHealth.,2016).Someofthesymptomsincludesdiarrhea,constipation,
nausea,vomiting, andweightloss.Max haddiarrhea,constipationbutthereisnoreport
ofweightloss, nausea, vomiting, or eating anyfood that has gluten. The text did to rule
, Version1and2
out,werenegative forceliacdisease.So, celiacdiseaseisnottheprimarydiagnosis.
• Hypothyroidism- E03.9: This is a condition wherebythe thyroid gland do not produce
enough of thyroid hormones. Some of the symptoms are fatigue, constipation, and dry
skin. Though, max has had constipation, but never complain of fatigue or skin dryness,
andthyroidfunctiontestwherenegative.So,weruleouthypothyroidismastheprimary.
• Constipation- K59.00: dissatisfying excretion of feces mark by infrequent stools,
difficult stool passage or both. Some of the characteristics include less three bowel
movementsaweek,hardstools,excessivestraining,prolongedtimespentonthetoilet,a
sense of incomplete evacuation, hard or small stools, difficulty passing feces, and
abdominaldiscomfort,suchaspain,andbloating. Thisseemstobethediagnosisbut
basedonthesubjectandobjectiveinformationgatheredconstipationonlydonotsoil pants and
underwear. This should be a supporting diagnosis.
AdditionalLaboratoryanddiagnostictests:
• UA/UrineculturetocheckforUTI/glucosuria.
• Thyroidfunctiontests: hypothyroidism
• Abdominalx-raytocheckforstoolimpaction:Resultshowingalargeamountofstool filling
the rectum and sigmoid colon.
• Antigliadinantibodies(IgA,IgE, IgG):Usetodiagnosedceliacdisease.
• Electrolytepanelincludingcalciumtocheckforhypokalemia,hypercalcemia,or
hyperglycemia.
Consults/Referrals.
• Nutritionistfordietarymanagement.
• Counseling,andbehavioraltherapymaybeconsideredduetoparents’divorcewhichmay be a
contributing factor.
TherapeuticModalities
Pharmacologicalmanagement/treatment:
• Dis-impactionwithpolyethyleneglycol.1.5g/kg/day,orally,dailyfor3days,and
maintenance dose of 0.8g/kg/day orally, daily, for six months.
Non-Pharmacologicalmanagement:
• Dietarychangesbyeatingenoughvegetables,eatinghealthieranddrinkingadequate
water until he sets up his regular bowel movement.
• Continuationoftoilettraininguntilthesuccessfulmaintenanceofaregular bowel
movement.
• Eatinghighfiberdiet,freshfruits,andfluidintakeof2000to3000ml/dayifnot
contraindicated.
• Beingphysicalactive
HealthPromotion:
• Earlychildhoodisatimetheparentsshouldstarttosetuphealthfuleatingpatternsforthe child
and family. These patterns should involve the consumption of vegetables, fruits, while
grains, lean means, and dairy products, and then minimize consumption of goods
case study cc;leaking stool Content; HPI
STATEMENT,HISTORY,PHYSICALEXAM
2025/2026
,Version1and2
Maxkingsi-humancasestudycc;leakingstool
Content;HPISTATEMENT,HISTORY,PHYSICALEXAM,TESTING,DIFFERENTIALDIAGNOSIS,
SUMMARY,PLANFORPATIENT,EXERCISES,EXPERTFEEDBACK,CASESUMMARY
,Version1and2
Maxkingsi-humancasestudycc;leakingstool
HPI
Max King is a 4-years Old Caucasian male child visited the clinic with his father with a
complaintofleakingstoolsinhisunderwear forthepast3-weeks.Fatherstatesthathischildhad
intermittentabdominalpainfor2yearsandhadexperiencedhardstoolsaswell.Healsoreported that his
child started having watering stools, 2-3 times in a day for the past 3-weeks. He went further to
explained that the abdominal pain usually starts after eating and gets better a few minutes.
According to max’s father, he states that his son is picky eater, and do not eat vegetables or
healthy.Maxisknowntoloveeatingfriedfoodanddessert,drinkthreecupsofmilksinaday, and do not
drink enough water.
Thefathermentionedthatmaxispottytrained,andhedeniesnauseaorvomiting,fever,bleeding with
defecation, and headache. He reported of straining when defecating.
Physicalexaminationrevealedadiffusetendernesstopalpationoftheabdomen.
Treatment/ManagementPlan
PrimaryDiagnosis:EncopresisandICD-10code:F98.1
• Encopresis sometimes called stool soiling can been defined as an intentional or
involuntarymovementofstoolsintotheunderwearorclothing.Itusuallyoccursintoilet
trainedchildrenwithdevelopmentalagethatisgreaterorequalsto4 years.Thechild usual resist
defecation which causes feces to be impacted in the colon leading to constipation, and
later followed by leaking watery stool (Colombo et al., 2017).
In most cases, it happens because a child has a chronic constipation. Some of the
symptomsincludetheneedtohaveabowelmovementwithlittleornowarning,loseor watery
stool, leakage of stool into the underwear, intermittent abdominal pain, constipation,
avoiding defecation, and urinary tract infections.
In this case Max has all the symptoms of encopresis, and both the subjective and
objectivedatasupportedthediagnosiswiththeabdominalx-raythatshowedimpacted large
stools in the colon.
DifferentialDiagnosis
• Celiac disease – K90.0: This is a genetic autoimmune reaction to eating gluten, a
proteinfound in wheat, barley, and rye, which can affect the gut, and other organs
(WoltersKluwerHealth.,2016).Someofthesymptomsincludesdiarrhea,constipation,
nausea,vomiting, andweightloss.Max haddiarrhea,constipationbutthereisnoreport
ofweightloss, nausea, vomiting, or eating anyfood that has gluten. The text did to rule
, Version1and2
out,werenegative forceliacdisease.So, celiacdiseaseisnottheprimarydiagnosis.
• Hypothyroidism- E03.9: This is a condition wherebythe thyroid gland do not produce
enough of thyroid hormones. Some of the symptoms are fatigue, constipation, and dry
skin. Though, max has had constipation, but never complain of fatigue or skin dryness,
andthyroidfunctiontestwherenegative.So,weruleouthypothyroidismastheprimary.
• Constipation- K59.00: dissatisfying excretion of feces mark by infrequent stools,
difficult stool passage or both. Some of the characteristics include less three bowel
movementsaweek,hardstools,excessivestraining,prolongedtimespentonthetoilet,a
sense of incomplete evacuation, hard or small stools, difficulty passing feces, and
abdominaldiscomfort,suchaspain,andbloating. Thisseemstobethediagnosisbut
basedonthesubjectandobjectiveinformationgatheredconstipationonlydonotsoil pants and
underwear. This should be a supporting diagnosis.
AdditionalLaboratoryanddiagnostictests:
• UA/UrineculturetocheckforUTI/glucosuria.
• Thyroidfunctiontests: hypothyroidism
• Abdominalx-raytocheckforstoolimpaction:Resultshowingalargeamountofstool filling
the rectum and sigmoid colon.
• Antigliadinantibodies(IgA,IgE, IgG):Usetodiagnosedceliacdisease.
• Electrolytepanelincludingcalciumtocheckforhypokalemia,hypercalcemia,or
hyperglycemia.
Consults/Referrals.
• Nutritionistfordietarymanagement.
• Counseling,andbehavioraltherapymaybeconsideredduetoparents’divorcewhichmay be a
contributing factor.
TherapeuticModalities
Pharmacologicalmanagement/treatment:
• Dis-impactionwithpolyethyleneglycol.1.5g/kg/day,orally,dailyfor3days,and
maintenance dose of 0.8g/kg/day orally, daily, for six months.
Non-Pharmacologicalmanagement:
• Dietarychangesbyeatingenoughvegetables,eatinghealthieranddrinkingadequate
water until he sets up his regular bowel movement.
• Continuationoftoilettraininguntilthesuccessfulmaintenanceofaregular bowel
movement.
• Eatinghighfiberdiet,freshfruits,andfluidintakeof2000to3000ml/dayifnot
contraindicated.
• Beingphysicalactive
HealthPromotion:
• Earlychildhoodisatimetheparentsshouldstarttosetuphealthfuleatingpatternsforthe child
and family. These patterns should involve the consumption of vegetables, fruits, while
grains, lean means, and dairy products, and then minimize consumption of goods
