He is not emptying: Stooling incompletely can allow build of feces. That can stretch the bowel and cause inadequate signals from the brain to the bowel for evacuation. Clean out is essential to constipation therapy. Daily measures are important afterward. Those should continue in cases of chronic constipation for 6-9 months. Consider peds GI evaluation if your pediatrician is out of ideas.
Answered 6/10/2014
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