At this point the doctor thinks that he is just constipated. His abdomen is full of gas except for a bunch of poop. So, even though Malachi often goes twice a day and his poop isn't hard for some reason he isn't fully emptying his bowel. We need to start Miralax to get things moving and then give his bowels two to three months to shrink back down to normal. We have to do some bowel "hygiene" training, too. He'll need to sit on the potty for ten minutes in the morning and ten minutes in the evening with his feet on a stool to give his bowel a good chance to empty completely. I guess that many kids his age just want to go and be done so they go some and then hop off with that bit of relief.
At this point, he doesn't think there is a lymph node causing this issue. I guess incontinence is a classic constipation presentation. Coupled with a gassy abdomen with a bunch of poop over by his hip makes the doctor very confident this is it.