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Preteen Encopresis Guide
"I have constipation, and I poop at school."
Interview with a 10-year-old.
Introducing a remarkably talented preteen!
 The student we interviewed was laid-back and really fun to talk to. |  He showed us his amazing talent by sharing his drawings. |
|---|---|
 He stated that he would much rather have us visit him at home than at our clinic. |  We asked him what he thought of the article we were writing for our website. |
We asked him what bothered him about his constipation.
 |  He reported that he feels that he needs to go all the time. |
|---|---|
 He said the school's toilet paper is too hard. |  According to him, toilet seats tend to be hard and leave body marks. |
We asked him for his thoughts on our
Constipation Guide.
 |  We showed him our draft version. |
|---|---|
 He was shocked. |  He immediately said use pictures of sad boys in the article. Because that is how they feel. |
 We asked him what the heading should be. |  He provided us with the article's title. |
 He basically said we have to call it what it is. |
Preteen Constipation and Encopresis Guide
Parents may read this too:
A Constipation and Fecal Incontinence Guide
How to use this guide:
- Please read this guide from beginning to end, as every section is important.
- Please also share this guide with your parents.
- We color-coded the sections so that after you have read it through the first time, you can easily jump to the sections you want to read again.
- We recommend you read it through several times, because every time you read it, something else may jump out at you.
- We use the black and white skateboard whenever we provide suggestions.
- We use the sunset skateboard when we share important facts.
What is constipation?
Constipation is when you have difficulty pooping.
How do I know if I have constipation?
We have a checklist you can use to see if you have constipation. Sometimes it is difficult to know. You can also take this check list to your doctor.
 |  You have had difficulty having a bowel movement for as long as you can remember. |
|---|---|
 You have a bowel movement only sometimes, and less than 3 x a week. |  You have hard poops or poops clogging the toilet. |
 You need to strain or push to have a bowel movement. |  You leak stool or have smearing in your underwear. |
 You avoid having a bowel movement and try to keep it in. |  You cannot feel when you need to go. |
What other symptoms can also be a sign of constipation?
 |  You are frequently not hungry. |
|---|---|
 You have stomach pain. |  Bloatedness. |
 You have a rash in your bottom area (around butthole) |  You are so tired of it, you feel like you want to hide your soiled clothes. |
Kids dislike it. Constipation, they say, makes them:
 |  Feel really stressed, |
|---|---|
 or really mad or frustrated. |  Some gets bullied at school. |
 Some feels lonely. |  Some feels it is their fault. |
Drop In Suggestions
 | When you feel really bad, |
|---|---|
 why don't you go talk to one of your parents? |  Try giving yourself a big hug. |
 It also helps to go play with your favourite pet. |  The tips in our guide will help the constipation - but you have to keep at it. |
Trictionary Facts:
More on constipation
 You are not the only one with constipation. |  There may even be another kid in your class with the same problem. |
|---|---|
 And if you have to wear pull-ups, you are also not the only one. |  Did you know, constipation can be the cause of urine leakage too. |
What causes constipation?
 |  The number one contributing factor: |
|---|---|
Withholding. Or not wanting to go. For any reason. |  Every person is different. So let's see what else can be a cause. |
Stress. |  Also a stressful event in your past that made you feel overwhelmed. |
 A high-fat or high-sugar diet. |  It's possible that you have a medical issue, so it is good to go see your doctor. |
Trictionary Fact:
-The constipation is not your fault-
Anatomy: What happens in my body when I have constipation?
Remember, constipation is when you don't poop well.
When you don't poop well, poop starts building up in your large intestine.
 |  The poop that piles up, makes your large intestine... |
|---|---|
 stretch out. Especially the bottom part. |  Then as the large intestine gets wider, more poop can build up, |
 which clogs things up, and leads to constipation. |  Then, when you don't poop well, the cycle continues. |
Creating more constipation, |  and this is why your problem don't seem to go away. |
Anatomy: What will happen in my body when I get better?
 | After a while, when you have been able to keep the bottom part of your colon empty, |
|---|---|
 it will shrink back to its normal size. |  But it may take time. |
Anatomy: What happens in my body when my bladder is also leaking?
 | The reason some kids have urine leakage too, |
|---|---|
is because their stretched out rectum, |  is leaning against their bladder, irritating it. |
 So all kinds of bladder symptoms can happen as a result, | due to constipation. |
Anatomy: What happens in my body to help me believe that the leakage is not my fault?
Why you can not stop the leakage, even if you try:
| Your body can’t just stop the leaking. Just like when you have diarrhea. |
|---|---|
 The opening where the poop comes out is like a rubber band. It can't stop fluids from leaking out. |  It's like how ice cubes can't stop water from moving around them. |
Why you can not feel the leakage:
 |  The leakage is the same temperature as your skin, so you can't feel it. If it was cold, you would have felt it. |
|---|---|
 Your brain does not know what to do and has decided to ignore that part of your body, so now you don't feel it. |  Just like your body has gotten used to the smell, and you don't smell yourself anymore. |
Why you do not have the urge to go anymore:
| Because your large intestine... |
|---|---|
has been stretched out, | the nerves in the area... |
 are having a harder time connecting to each other, | and now the nerves are having difficulty signaling an urge to you. |
Trictionary Facts:
We have a constipation buster plan.
Before we start explaining the plan, we have to let you know:
 |  You can retrain your body to make things better! |
|---|---|
But it may take some time. |  The longer you have struggled with constipation, the longer it may take to retrain your body. |
 Especially in the beginning. |  You may have to deal with relapses and failures for a while, which is normal. |
 Sometimes it does go away by itself, | but it is better to treat it. |
But the plan requires courage!
 |  It is quite hard to treat it, we know, |
|---|---|
 but if you take one step at a time, you will get there. |
Our Constipation Buster Plan.
But wait!!
Trictionary Facts:
Scientists have found the best way to improve bowel movements, and it all comes down to how you sit and push.
A: First, learn how to sit on the toilet correctly.
 |  First, find a box to use as a footstool. Place it in front of your toilet. |
|---|---|
 Sit on the toilet and place your feet on the box. |  Place your feet and knees apart, and lean slightly forward with your back straight. |
 Your knees should be higher than your hips. |  Next, relax your whole body, even your face and jaw. |
Second, learn how to do belly big, belly round.
 | While in that squatting position, |
|---|---|
 you need to make your stomach big and round. |  You know when you lie in a hammock and your stomach pulls in when you look down? It's not like that. |
 It's round, like a ball. (Not hard as a rock - that is too much.) |  Then, get ready to gradually push - like a plunger- from top to bottom. |
 But wait! |  Before we go on, we need to teach you something cool. |
Third, learn that it is all about using the right words!
 | When you push, you need to use the right words, |
|---|---|
 so that your body can know to use the right muscles. | and using the right words, will also help with belly round, belly hard. |
 When you push, you are going to use "Dragon Poo". You can also use "hard", or "mooo". | Practise that. It is better to say the words out loud, but saying it in your mind may also work. |
Fourth, learn that the push should be short and slow.
 |  Begin by doing a short "dragon poo" push. And then wait! |
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 Wait for your body to do the rest on its own. And if your body does not push the poo out all by itself, |  then repeat the dragon poo push. Only once or twice more. |
And if your body still does not push the poo out by itself, |  then keep reading till our medication section, because that is what will help you the most. |
You want to avoid straining. |
Fifth, understand that this may take time.
 | Remember, you are training your body. |
|---|---|
Just keep practising. Your body just forgot how to do it. |  It may take weeks to months for your body to relearn how to do it right. So just keep going. |
 Alarm ClockMake sure you do not sit on the toilet for more than 5 - 10 minutes and remember, don't strain. |
Drop In Suggestions
You need wiping tips!
 | First, you need supplies, so go get the help of a parent. |
|---|---|
 Second, make sure you have big pockets without holes in them. |  If the toilet paper is too hard, plan on using soft wipes. |
 Buy ultra mini travel wipes/pocket wet wipes, that will fit in your pocket. |  Buy a dental tool mirror so you can check... |
 to make sure you wipe really well. |  Have your mom buy a cream if your skin is raw. The smallest tube you can get. |
 If the school bathrooms are filthy, get a small spray bottle with disinfectant so you can quickly wipe the seat clean. |  Important, buy small black plastic bags to put your used stuff in. You can find them at pet stores, or online. |
 After you wiped, throw the bag with the wipes in the bin. |  Remember! Never flash wipes down the toilet! |
 Make sure you wash your hands really well afterward. | Remember, even if you wear pull-ups, wear clean clothes every day - including shirt and socks. |
B. Find a bowel routine.
 | Our bowels works best when it has its own special time during each day. |
|---|---|
 Try and have a bowel movement 20 min after each meal. |  It takes that much time for your body to push the food out by itself. So go then. |
 Choose a time in the day after a meal that will work best for you. |
C. If you can, do these exercises on your way to the restroom.
 |  Walk - take the long way to the restroom and swing your arms. |
|---|---|
 Any kind of leg swings |  Karate kicks |
D. Focus on your stomach
 |  Start with at least one portion of vegetables and fruits a day. |
|---|---|
 Ideally you should have five portions of fruit and vegetables a day. |  One portion equals one handful. Aim for two handfuls of fruits and three handfuls of vegetables each day. |
Limit high sugar and high fat foods. |  Aim to drink 7 - 8 cups of fluids each day, primarily water. |
Looking after your stomach also includes:
 | Trying to feel when you need to go. |
|---|---|
 Going when you need to. |  Not sitting with it crunched up stomach all day. |
 Giving yourself a belly massage when you feel constipated. |  Your tummy loves it when you relax in nature. |
More exercises to:
1. Make your intestines move.
2. Send blood flow to them so they work better.
3. Strengthen your core.
 | Run whenever you can. |
|---|---|
 Swing or hang if you can. |  Hang upside down. |
 Punching exercises are good for strengthening your belly. |  Go explore nature around where you live... |
 |
Your constipation coaching team:
What happens when you see your doctor?
First, the doctor investigates.
| First, the doctor will evaluate you, |
|---|---|
 and check if everything is working ok. | Then the doctor will look into your constipation. |
 The doctor will ask both you and your parent some questions. | Please feel free to ask your questions. |
Trictionary Facts:
X-rays are not just for bones.
You can see constipation on an X-ray!
The doctor may send you for an X-ray of your belly.
Second, the doctor, you, and your parents will develop a plan for your constipation.
Your doctor may start with a clean-out:
 | Your doctor may suggest a clean-out to get rid of the constipation. |
|---|---|
It is a good idea to pick a weekend since you will visit the toilet a lot. | Your doctor will give you some medication to help with the clean-out. |
 | |
After the cleanout, your doctor may suggest a maintenance program:
| The maintenance program may include a few more cleanouts. |
|---|---|
It may also include daily medication for at least 6 months to a year. | Together with the medication, follow everything we suggest in this guide. |
Remember, the routine, how to push, how to sit on the toilet, | eating the right foods, |
drinking water and everything else we suggested. | It does take a little while... |
to shrink your colon. |
It can also help to see a pelvic floor therapist.
Let's look at what the first visit may look like.
 |  First the therapist will evaluate you. |
|---|---|
 Feel free to tell them you went through this guide. |  Your therapist will make sure you understand... |
everything that is in this guide. |  So feel free to come with questions. |
 Together with your parents, you may be asked to fill out a diary in the coming week. |  The therapist may look to see if your joints and muscles are affecting your constipation. |
They may evaluate your stomach. |
Later visits:
 |  We will teach you anatomy in a fun way. |
|---|---|
 You may play balance games, |  and strengthening games. |
 So your therapist may give you exercises to do at home. |  Some kids have a hard time feeling messages their bodies give them. |
 Your therapist may teach you how to feel those message, like the urge to go. |  You may be taught some breathing exercises. |
They will teach you a few ways to massage your belly. |  We could also use biofeedback, where you can see on a... |
 computer screen how you pelvic floor muscles work. |
I do not feel comfortable seeing my doctor or a pelvic floor therapist. What do I do?
 |  Ask your parents to find you a therapist who is comfortable working with kids, |
|---|---|
 who knows a lot about the intestines... | and constipation. |
 Ask if they can come see you at home, but they usually have a clinic. | If you have studied our guide, then you know A LOT. They will be very impressed. |
 Pelvic floor therapists like to play and working with kids, so that helps a lot. |
You
Matter
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