Timmy is a 5 y/o boy that presents to your office with a 6 month history of constipation and secondary encopresis. He has had hard, painful stools over that same time period. He averages one BM every 2-3 days. When he does have one, he usually screams. Mom tries to get him to go to the washroom every day after breakfast, but he often tries to withhold a BM by crossing his legs. If he has a BM in the toilet, it is often noted to be large diameter and can clog the toilet. He soils his underwear frequently and is often unaware that it is occurring. He started having this issue around the same time that he started going to kindergarten. He has had many problems associated. He was diagnosed with a fissure 2 months ago associated with blood in the stool that has seemingly resolved. He had an E. coli UTI 2 weeks ago that was successfully treated. He has had to pee more frequently than usual over the same time period, but has no enuresis. He is teased by others and is very shy and embarrassed about the topic in the office. He is otherwise well, has no other GI or other systemic symptoms. He is growing and developing appropriately, and was toilet trained successfully by age 4. His diet consists of approximately 4-6 servings of fruits and vegetables, and mom has been pushing lots of fiber on Timmy lately. He drinks 6 glasses of fluids per day, and is active. PMHx: Unremarkable. He passed meconium within 12 hours. Meds: None Allergies: None FHx: Unremarkable. His older sister has issues with constipation as a child as well. Examination is unremarkable – notably, neurological exam revealed no sensory or motor deficits. Abdomen is slightly distended with stool palpable in LLQ. There were no lower back skin defects. Perianal inspection reveals soiled underwear, no skin tags or fissures. The anus is normally located and patent. Normal anal wink and sphincter tone is observed. The rectum is distended and full of hard stool. What would be the most appropriate initial management?