Probably appropriate to see a peds GI at this point. The starting outcome will likely be Miralax and timed toileting, but it's good to make sure nothing else is going missed.
Sorry in advance for the long post!My 8 year old son has had significant trouble with bowel training since initiation of potty training in general. What I believe started as an aversion to pooping due to distraction or not wanting to miss out on anything exciting while he was on the toilet, evolved into chronic constipation and an aversion secondary to pain. This was initially treated with Miralax and pushing fluids. However, he continued to have various amounts of poop in his underwear on almost a daily basis, and struggled with having regular bowel movements, alternating between small pebbles to impossibly large logsBecause he spends half of his time with his father and half with myself, there have been some inconsistencies in addressing this. I recently had a long discussion with his father and we decided to give an impaction appropriate dose of Miralax to encourage complete emptying and then start on a consistent maintenance dose at both houses. Admittedly, we had both dropped the ball on this. My concern now is that my son has recently had a couple of episodes of full on incontinence while out running errands. When I talked to him about always letting me know he has to go so we can find a restroom, he explained that he does not feel and urge to go, and only realizes what has happened when he feels it in his pants. I recognize that prolonged constipation can decrease urge sensation and believe this is what has happened. I do think this is still a tiny bit related to not wanting to stop what hes doing and sit on the toilet for the appropriate amount of time to have a big poop. All of that background is basically to ask, should I seek out a pediatric GI specialist? Or is this something that can be solved by going back to the potty training basics (timed toileting and having him sit on the toilet for a while). Is Miralax an appropriate choice for his age/symptoms? Does this warrant a consult with a therapist? Of note, I am aware that some of these symptoms can be a trauma response, however I am very confident that is not the case with him. Despite our divorce, my ex remains a caring father to both of our children, and neither child is left in the care of any suspicious characters. Any guidance would be greatly appreciated!