Constipation and faecal incontinence: Case

This girl shows the full picture of functional constipation with retentive faecal incontinence: infrequent large painful stools, an anal fissure driving withholding, toilet avoidance, and daily overflow soiling around a palpable faecal mass, all with normal growth and no red flags. The story allows a positive functional diagnosis, while the fissure, the fear of the toilet, and the family and school strain are the factors management must address. ^[1]

Clinical findings

The pattern is clearly functional and retentive. The large hard stools, pain, and anal fissure explain the withholding, and the daily leaking is overflow of soft stool around the impaction confirmed by the palpable faecal mass. The normal growth, normal spine, and normal lower limb neurology, with an onset well after infancy, make Hirschsprung disease and other organic causes unlikely, so no routine bloods or abdominal radiograph are needed. The fissure is a consequence of the hard stool rather than a primary diagnosis, and safeguarding is considered but not suggested by the history. ^[1]