17 He urinates 3-4 times a day without incontinence, urgency or any problems with emptying the bladder and there is no enuresis. He eats a variety of foods and has regular breakfast, lunch, and evening meals. He drinks 3-4 glasses of water or milk per day. Abdominal ultrasound of the rectum shows a dilated rectum of 3,7 cm and he does not feel the urge to poop. The abdomen feels soft and nontender, but some faeces can be felt in the lower left side. At Home and School Divorced parents and he lives with each parent a week at a time. Has two smaller siblings, 5 and 3 years old. He is in his first year in school and is very much into playing video games with his friends over the interne Signs: what are the signs/problems If using the Rome IV criteria there are signs of functional constipation. o Leakage of faeces at least once a week o Withholding his stool in school o Large stools in the toilet sometimes. o Widened rectum above 3 cm without the need for pooping. Problems in his daily life Not going to the toilet in school A lot of sitting in front of the computer. A different approach from the two parents could make it difficult to maintain routines Rome IV criteria: Must include two or more of the following occurring at least once per week for a minimum of 1 month with insufficient criteria for a diagnosis of IBS: Two or fewer defecations in the toilet per week in a child of a developmental age of at least 4 years At least one episode of faecal incontinence per week History of retentive posturing or excessive volitional stool retention History of painful or hard bowel movements Presence of a large faecal mass in the rectum History of large diameter stools which can obstruct the toilet After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
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