Here is an email I recently received, reprinted with the parent's permission:
Hi Dr. Tom,
I'm currently pretty livid, and a little bit defeated. My 3.5 year old son's pediatrician referred us to a pediatric GI clinic to rule out any other underlying causes for his constipation. He's on a very large daily dose of Miralax and his poops are extremely soft.
We saw the nurse practitioner at the clinic. The good news is that she doesn't think there is anything else going on in addition to what we already know: his rectum is stretched out, so things do not work exactly the way they should.
We were in a pretty good place before the appointment. He was having a large poop daily and, with a few recent exceptions, he was going in the potty. It took us months to get there. But she did a rectal exam and not in a way that I liked. At all.
She didn't actually tell him she was going to do it. She made him cry trying to get him on his side, until I stepped in and got him to roll over without tears. Then she just told him, "This is going to feel like pooping backwards," and stuck a finger in. Given that he has fear issues regarding pooping, that does not seem like a wise thing to say to comfort him.