A 4-year-old female with a history of chronic constipation since 3 months of age presents to your clinic. She has remained at the bottom of her growth curve and has a diagnosis of failure to thrive. Her urologist had referred her to a gastroenterologist after finding a large fecal impaction during a renal ultrasound that was felt to be causing urinary retention. Despite multiple laxative regimens implemented, as well as daily enemas and in-patient disimpactions, she is unable to reliably empty her colon and was referred to the colorectal surgery clinic for consideration of surgical options.