1. Please take your child to a pediatric gastroenterologist or pediatric surgeon who specializes in constipation / bowel problems (not just a general doctor). 2. They will most likely do: • Abdominal X-ray or contrast enema to see how big the rectum really is • Sometimes anorectal manometry or transit study • Start disimpaction if there is still a lot of hard stool inside (often needs medicine or short hospital stay) 3. Typical treatment plan (not home-only): • High-dose laxatives (lactulose, PEG 3350/Movicol, liquid paraffin) for 1–3 months to empty and soften • Maintenance laxative for 6–18 months (yes — long time) to prevent re-stretching • Toilet training schedule (sit on toilet 5–10 min after every meal) • Behavioral support so child stops holding

• At home right now you can start: • Give lots of water (2–2.5 liters/day) • High-fiber foods: fruits (apple with skin, pear, kiwi, papaya), vegetables, oats, whole-grain bread • 1–2 spoons flaxseeds or isabgol (psyllium) with water at night • Encourage sitting on toilet after every meal even if no urge (use footstool to raise knees higher than hips) • Praise and reward every successful toilet visit (no punishment for accidents) • Do NOT force or scare the child to pass stool — it makes withholding worse. • Do NOT rely only on home remedies/enemas/suppositories long-term — they can make the rectum even lazier. Realistic outlook With proper medical treatment started now: • Most children see big improvement in 3–6 months • Normal bowel habit returns in 6–24 months for majority • School life becomes normal again (no more embarrassment or missing classes) The longer you delay specialist care, the longer and harder the recovery becomes. Please book the appointment this week — early treatment makes a huge difference. If you want help preparing questions for the doctor or explaining to your child in a gentle way, consult with me online. Take care — your child can get better