### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My daughter is 4, and has had 2 previous bouts of having stool back up all the way to her ribs. It always starts with the symptoms of a uti, and the drs can find no infection or anything until she spikes a fever. She s on a high fiber diet, and is very regular with her bowel movements, yet still has this trouble. Last time the xray revealed that her colon was stretched. Drs are stumped. Any idea what it could be?

### output:

Hi there, The backed up stool and tendency to urinary tract infection does point to the idea that she could be constipated, despite being regular.  Regarding the frequency of bowel movements, do note that different people tend to have different bowel needs, up to 3 times a day is accepted as normal.  So she could actually be going daily and still be relatively constipated. What we are aiming for is the right consistency of stools, which is long and sausage-like, with or without cracks.  If you need more visual guidance, look for the Bristol stool chart online, and aim for Type 3 or 4.  It is good that she is taking enough fibers, but also pay attention to her habits and stress to her that she needs to go when she feels like it even if it is more than once a day.  Constipation often occurs at this age because this is when they are getting better at holding it in, and prefer other exciting activities to sitting in the toilet. The other rarer possibility would be that she has a mild form of Hirschsprungs disease, which means that some nerves are missing from the end of the colon, making the evacuating of stool difficult.  Most people have this diagnosed as babies, but if its very mild it can be missed.  It might be more likely if she had delayed bowel movement more than a day after birth, or had tendency to constipation even as a baby.  You will have to discuss with your doctor on this possibility, because confirmation would be needed with a rectal biopsy. Hope this helps, and all the best to you.