It is important to come to your appointment prepared, with notes on your child’s symptoms as well as his recent diet and medications. It might even be helpful to keep a “poop chart” for a few weeks beforehand. You’ll probably be asked questions like:

• When did your child beginning experiencing symptoms?
• Does anything seem to improve or worsen his symptoms?
• Have his symptoms been continuous or occasional?
• Is there a family history of digestive problems?
• Does your child strain with bowel movements? Have you seen blood?
• Has there been any change in your child’s medications or dosages?

The physical exam will likely include placing a gloved finger into your child’s anus to check for abnormalities and the presence of impacted stool. Rarely more extensive testing might be conducted for severe cases, including:

• Colonoscopy
• Barium enema X-ray
• Rectal biopsy (to determine if normal nerve cells are present)
• Anorectal manometry or motility test, where a catheter is placed in the rectum to measure the coordination of the muscles your child uses to pass stool
• Colonic manometry, which measures the contractions of large intestine and is done during a colonoscopy
• Transit study or marker study, in which your child will swallow a capsule containing markers that show up on X-rays taken over several days to see how they move through your child’s body