It sounds like he might suffer from functional constipation or retentive encopresis, which is involuntary fecal soiling. Generally, in about 90% of cases, ncopresis develops as a consequence of chronic constipation, with resulting overflow incontinence. Chronic constipation with irregular and incomplete evacuation results in progressive rectal distension and stretching of the internal/external anal sphincters. As a child habituates to chronic rectal distension, they may no longer sense the normal urge to defecate. Eventually, soft or liquid stool leaks around the retained fecal mass. Many children voluntarily withhold stool in response to the urge to defecate for fear of pain or a preoccupation with not interrupting social activities. Hirschsprung disease can worse constipation. I would recommend: -increasing fluids and fiber -the fecal impaction needs to be removed to help with maintenance therapy -disimpact with miralax (polyethylene glycol) for 3 days. Or Cremaffin syrup. -avoid frequent and repeated rectal exams, enemas, and suppositories -Once stools are regular in frequency, child should sit on toilet twice a day at the same time each day for 10 to 15 minutes and for 10 to 15 minutes after meals. Incorporate positive reinforcement for successful bowel movements. -reduce cows milk products -avoid excessive consumption of bananas, rice, apples, and gelatin.