11 www.aseba.org ) or Strength and Difficult Questionnaire (SDQ) (see: www.sdqinfo.org/a0.html) to gather information about a child’s behaviour if there is a cause for concern. Behavioural problems interfere with treatment and result in less favourable outcomes. 18-20 It will be useful to look at each of these three items separately, but it is important to note that these elements are interrelated. 5. Therapeutic Interventions Toilet training for constipation Constipation should be addressed before treating daytime incontinence. Faecal impaction causes pressure on the bladder neck and urethra which may be contributing to LUTS. Treatment consists of a toileting program and medication with laxatives and healthy lifestyle advices.1,4,14 Toileting program: The child is advised to go to the toilet for approximately five minutes after meals (to make use of the gastrocolic reflex) to try to defecate. The child should be encouraged to actively push, with the feet firmly on the floor or take support of a footstool if necessary. The aim is to flex the hips beyond 90 degrees which allows the anorectal angle to straighten, making it easier to defecate. The child should be actively involved in this and should not, for example, read a book which distracts his/her attention. To optimize the effect of the toileting regime, it is good to give the child a specific task. For example, children can be asked to actively push ten times with the belly and hold it for a while, then relax and then press ten times again. The results are recorded in a defecation diary, distinguishing between spontaneous defecation and planned defecation during toilet sitting. This will help the child to re-learn the sense of urgency. The diary gives an insight into the progress of the treatment and will have a motivating effect on the child and parents. In doing so, it also provides an
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