18 Parents blame him for the faecal leakage and tell him to go to the toilet to avoid leakage and don’t be lazy. Assessment & engage phase: Request for help, Referred from the outpatient clinic because of faeces leakage. Correct diagnosis, With a normal height and weight and a previous history of normal bowel habits, it strongly tells us that he has not got any physical illness causing his problems with constipation. It is always good to inspect his lower back, genitals, and anus at least one time to assure that it’s looking normal and that he has no scars or bruises giving suspicion of sexual abuse. This could have been done by the general practitioner, but not always. The use of the Rome IV criteria gives the correct diagnosis of functional constipation he fulfils four of six criteria44,14. Use the Bladder and Bowel Diary and British Stool Scale to ask the child about the type of stool. Treatment goals, Stop faecal leakage. Stop withholding behaviour. Establish good bowel habits. Treatment plan According to the ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) 14 guidelines from 2014, there are three main steps of treatment; evacuation of old stool, long treatment with softeners to prevent relapse and make it pleasant to poop and lastly toilet regime with toilet visits every day. Treatment phase: Psycho education/instructions
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