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Parents say that the child clings to a furniture or parents and rises on the tips of his toes, stiffens his legs, curls like a worm, cannot stay in place, and / or is hidden in a corner. Stool retention attempts can be defined by parents as an inadvertent defecation attempt.
-Rectal examination (recommended at least once) With this examination, perianal sensitivity, anal tone, width of the rectum, mass, blood, mucus, stool bursting when finger is pulled, the presence of anal folds, whether the stool is in the rectum and the consistency of the stool are learned.
LABORATORY METHODS Complete blood count, urinalysis and stool tests (parasite, digestion and occult blood) should be performed routinely in children with all constipation. Further investigations are required in resistant cases.
Note: Patients are asked to fill in a 3,5,7-day bladder-bowel evaluation form. As a result, detailed information about bladder and bowel functions is obtained.
In order to diagnose functional constipation in children, the Rome III criteria questioning the frequency of defecation, the desire to hold stools, the presence of stool mass in the rectum, and the shape of stool are used.
2-INFORMATION If functional constipation is diagnosed; While planning the treatment, first of all, bowel and bladder functions, the mechanism of constipation, and the treatment program to be applied should be explained in detail to the family. If there is poo incontinence, the child and family should be informed in detail about poo incontinence. If poo incontinence is caused by constipation, it is important to know that it is due to overflow and not deliberate behavior. The family should be told that a positive and supportive attitude should be provided. The family should be well organized, especially in the treatment of constipation with overflow incontinence. The motivation of the family and the child is very important in terms of the success of the treatment. Education should be repeated from time to time in the treatment process and the mechanism of constipation should be explained over and over again. The family should know that relapses are frequent, treatment takes a long time and constipation may continue in adolescence and should be careful about this issue.
3-REMOVAL OF SOLID FOOT The general approach in the treatment of cases with functional constipation is to first determine whether there are fecal deposits. Fecal deposits can be palpated during physical examination. The dilated rectum is filled with fecal mass and excess stools can be seen on plain abdominal radiography.
If there is accumulated poop, the accumulated poop must first be removed from the intestines. This is done orally or rectally.
4- DRUG TREATMENT The interventions and drug doses to be made during the treatment should be kept to a minimum. Drug treatment should be given until a regular defecation habit is formed. However, the aim of treatment should be to create a regular defecation habit without using medication. For this, many treatment options should be applied together.
Pooping should be ensured at the planned hours or hours by evaluating the bowel diary, and time should be spent in the toilet at the same time every day until you sit on the toilet and poo. In this process, materials that help to spend time can be used (toys, books, etc.).
6-PELVIC BASE MUSCLE TRAINING It is aimed to reach normal pelvic floor muscle activity with pelvic floor muscle training. The training that aims to reach the required EMG Muscle activity values when we contract and relax our pelvic floor muscles is pelvic floor muscle training.
7-BIOFEEDBACK. This treatment is applied to patients with bladder and / or bowel incontinence, difficulty in defecation due to abnormal pelvic muscle contractions, and pelvic floor dysfunction.
The pelvic floor muscles are a hammock-shaped muscle group that extends from the bone between our legs to the coccyx, and plays an active role in the control of urine and poop. It provides this control by being loose at the time of urination and defecation and by being contracted at all other times. It works voluntarily, but it is located in the body due to localization. For this reason, many people contract or relax this muscle without being aware of the existence of such a muscle. In possible pelvic floor muscle dysfunction, it may be necessary to strengthen or relax the muscle. Since it is very difficult to operate a muscle that we cannot see and touch, it has become necessary to use biofeedback therapy. The basis in this treatment; Electrodes that are used to detect the activity of the muscle are placed on the skin area above the butt hole, which we call the perineum. These electrodes are linked to devices specially designed for biofeedback. Thanks to the electrodes, when the child contracts or relaxes the muscle, graphics are created on the computer or animated characters act according to the activation of the muscle. Thus, the child learns to use the muscle correctly. For example, when the child contracts the pelvic floor muscle, the plane takes off and when it loosens, it starts to descend. In this way, the child exercises the pelvic floor muscle while playing computer games. Over time, the muscle regains its normal function.