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Persistent constipation at 11 years is a significant challenge and difficult to manage without the help of multiple health care givers including prefereably a pediatric gastroenterologist and a psychologist.
The basic cause of the symptoms is the fear of painful defecation, that is causing him to avoid passing stools and does not allow him to relax.
We need to use a local anesthetic cream to anesthetize the bum temporarily when he is going to the bathroom, and then use a regular stool softener without stopping it for at least a few months to a few years!
All the best,