In our first international episode, Dr. Peter Lu and Dr. Temara Hajjat cross the Atlantic (virtually) to talk to the illustrious Dr. Marc Benninga from Emma Children's Hospital/Academic Medical Centre in Amsterdam, the Netherlands. Dr. Benninga is not only our first guest from our sister society ESPGHAN, but also the first Olympian and perhaps the first with a Wikipedia page.We bring in the European authority on pediatric constipation to talk about how he evaluates and treats children with constipation that has persisted despite our usual treatment with oral medications.  We compare and contrast the practices in the United States and the Netherlands.Learning Objectives1) To understand different approaches to the evaluation of a child with constipation refractory to oral laxatives.2) To understand the role of rectal irrigation in the treatment of a child with constipation refractory to oral laxatives.3) To review the evidence on pelvic floor biofeedback therapy in children with suspected pelvic floor dyssynergia4) To recognize the differences in practice among pediatric gastroenterologists in the evaluation and management of children with intractable constipationCME for NASPGHAN members is available here!References:Mosiello G, et al. Consensus Review of Best Practice of Transanal Irrigation in Children. J Pediatr Gastroenterol Nutr. 2017.As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Produced by: Peter LuSupport the showAs always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Follow us on Twitter, Facebook and Instagram for all the latest news and upcoming episodes!