A new study published in the Journal of Pediatric Surgery presented a protocol to treat idiopathic constipation. In this study 215 patients were treated of which 56 were males. The participants were between 1 20 years of age. Here a contrast enema was performed in every patient and when indicated patients were initially submitted to a clean out protocol. All patients were started on a Senna based laxative. The initial dosage was empirically determined and adjusted daily during a one week period based on history and abdominal radiographs until the amount of Senna that empties the colon was reached. The management was considered successful when patients emptied their colon daily and stopped soiling. However if laxatives dose induced abdominal cramping distension and vomiting without producing bowel movements patients were considered non manageable. The results revealed that 74 of the participants presented encopresis while 32 needed a clean out. After a week of treatment 84 of patients achieved successful management with an average Senna dose of 67mg. However on 16 patients the treatment was unsuccessful 19 were non manageable 3 noncompliant and 12 continued soiling. At a later follow up at a median of 329days the success rate was 81 . This study designed a successful protocol to manage idiopathic constipation. The key points were summarized as clean out before starting laxatives individual adjustments of laxative and radiological monitoring of colonic emptying.1 Reference 1. Bischoff A Brisighelli G Dickie B Frischer J Levitt M Pe a A. Idiopathic constipation A challenging but manageable problem. Journal of Pediatric Surgery. 2017. doi 10.1016 j.jpedsurg.2017.09.022.