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The anatomy section is currently under construction and being reviewed
Preteen Encopresis Guide
"I have constipation, and I poop my pants 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 |
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 He stated that he would much rather have us visit him at home than at our clinic |  We asked him what he thought of this article we were writing for our website |
We asked him what bothered him about his constipation and overflow leakage.
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 He reported that he feels that he needs to go all the time |  He said he does not like the school's toilet paper - it is too hard |
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 He felt the toilet seats are too hard too, and leave body marks on your butt when you get up |
We asked him for his thoughts on our
Constipation Guide.
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 We showed him our draft version |  He was shocked |
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 He said use pictures of sad boys in the article. Because that is how they feel |  He also added that we must call things what they are and not sugarcoat it |
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 We asked him what the heading should be |  He provided us with the article's title. "I poop my pants at school" |
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Preteen Constipation and Encopresis Guide
Parents may read this too:
A Constipation and Fecal Incontinence Guide
This guide was written for you
And for others going through the same as you
 Please read this guide from beginning to end, as every section is important |  It is long because we tried to give you as much information as possible |
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 Actually, it is more like a book than a guide, so take your time |  But you won't get more information like this anywhere else, all in one place |
 Please also share this guide with your parents |  We organized the sections using color codes so that after reading it once, you can easily jump to the sections you wish to read again |
 We recommend you read it through several times, because every time you read it, something else may jump out at you |  The pictures are important |
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 Because the pictures may help you think deep |  And help you understand things better |
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 Since this guide is similar to a picture book |  It may be better to use a bigger screen when reading this |
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 Also, if there are any pictures you don't like |  Then remember, that picture was made especially for someone else. We hope there will be a favourite picture for everyone |
 We use the black and white skateboard picture whenever we provide SUGGESTIONS |  We use the blue background skateboard picture when we share important FACTS |
Information Station Section
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 checklist with you to your doctor.
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 1. You have had difficulty having a bowel movement for as long as you can remember |  2. You have a bowel movement only sometimes, and less than 3 x a week |
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 3. You have hard poops or poops clogging the toilet |  4. You need to strain or push to have a bowel movement |
 5. You leak stool or have smearing in your underwear |  6. You avoid having a bowel movement and try to keep it in |
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 7. You cannot feel when you need to go |
 But that checklist is not perfect. There is one thing that is missing |
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 In kids, any kind of combination of poop can be part of constipation. Soft poop, runny poop, hard poop, big sized poops, three times a day poops etc. Even occational easy poops |
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What is overflow leakage?
Soft or liquid stool leaks around a backed-up, hard mass of poop
Common signs of overflow leakage: |  1. Stool or watery stain in your underwear |
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 2. All of the same symptoms mentioned under constipation |  3. The leakage happens at least once a month, for at least 3 months |
 4. Another sign of overflow leakage is when you have a rash in your bottom area (around butthole) |
What other symptoms can also be a sign of constipation and overflow leakage?
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 You are frequently not hungry |  You have stomach pain |
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 Food may taste different |  Bloatedness |
 One boy reports that he is thirsty all the time, but does not like to drink water |  Another sign you have constipation is when you hide your soiled clothes |
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Kids dislike it. Constipation and overflow leakage they say, makes them:
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 Feel really stressed |  Feel really mad or frustrated |
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 Some feel extremely lonely |  Sometimes they feel like they can ignore their problem, but other times they feel really overwhelmed |
 Some feel it is all their fault |  Some boys may feel like they hate themselves |
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 Some feel like there is no hope and that they are going to have this problem forever |  Some find that their problem is constantly on their mind |
 Their problem makes them feel like they are not good enough, daily expectations |
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 The whole situation makes them feel tired all the time |  When no one else in their family has had this problem before, they feel like they do not belong |
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 The kids don't understand why, but they feel mad at their mom and dad |  They want to try and hide their bodies |
Some other consequenses of constipation may include the following:
 Some gets bullied at school |  If other kids say they smell something, then the kids with constipation have learnt strategies to say it is not them |
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 Sleepovers seems to not be an option |
 Some kids report that they don't want to participate in physical activities - especially if it involves sweating |  They avoid getting close to their peers, because what if someone smells them |
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 They do not like to clean themselves properly because who wants a daily reminder of their problem |  They feel like they do not want their body. They feel like their body is not their friend |
 Most boys think the problem is their fault |  Some say it feels like their doctor don't seem to understand their problem either |
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 So far avoiding and ignoring seems to have been the best thing to do |
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Drop-in suggestions
For when you feel bad
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 A lot of times when people feel bad, they cannot feel their bodies. It is as if their body has gone numb |  Using strategies to help you feel your body again may be helpful |
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 Why don't you hug yourself using a blanket. It is ok to cry |  Hug yourself using your arms. It also helps rubbing your body. See what works better. Hard rubs or light rubs. |
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 Go soak in a tub, feeling how you relax. Look how this boy is feeling the water running through the shampoo on his head |  Go lie on the ground and feel the ground under your body and your breath going in and out |
 Another good idea is to talk to someone - like your parents |  Call a friend |
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 Or go talk to a buddy who cannot talk back, but who will just listen |  Go hang out with a brother or sister |
 Find something that makes you relax |  Play with your favourite pet |
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 Find a safe place where you can go for a walk |  And last but not least, find any activity that you would call "self love" |
 Oh wait! One more: Search for a plan - that is what we are here to help you with |
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Trictionary facts:
More on constipation
Did you know?
 You are not the only one with constipation |  There may even be another kid in your class with the same problem |
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 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 |
 Constipation is a modern problem with kids all over the world struggling |  In many the problem started at a young age |
Pile-up Causes Section
What causes constipation?
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 The number one contributing factor: | Withholding. Or not wanting to go. For any reason |
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 Number two: Every person is different. So let's see what else can be a cause of constipation: |
Stress |  A stressful event in your past that made you feel overwhelmed |
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 A high-fat or high-sugar diet |  It could be that it runs in your family |
 A variety of toilet fears can cause constipation |  It's possible that you have a medical issue, so it is good to go see your doctor |
Trictionary fact:
It is not your fault
-Overflow leakage is not your fault-
 Overflow leakage is not your fault because: |  You did not do anything deliberately to your body |
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Road Slow-downs Section
Anatomy of your GI system
 Let's call the system in your body that makes you poop, your waste system. Also called the GI sytem or gastro-intestinal system. Gastro=stomach Intestinal=intestines/colon |
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 The GI system runs all the way from your mouth to your poop hole or anus |
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 After you swallow, your food travels down the esophagus (the long upright pipe at the top in the picture) to the stomach. In this picture, the liver is the big brown organ, sitting like a hat on the stomach. Below the stomach you have the large intestine wrapping around the small intestine like a picture frame |
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 In your stomach, the food gets all mixed up |  Like your laundry in a washing machine |
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 From the stomach, the food goes into the small intestine (the middle curly part in this picture) |  The small intestine is 22 feet long! |
 It needs to be that long to absorb all the water and nutrients the body needs |  The food continues its journey from the small intestine to the large intestine |
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 The large intestine is where the food turns into waste |  Here more water and salts are absorbed |
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 The last part, the rectum acts as a TEMPORARY storage room for poop before it leaves the body |  For proper absorbtion of that water and salt, it helps if the poop does not go through the large intestine too fast or too slow |
The place where the poop should be stored is in the loop part, just before/above the rectum, not IN the rectum |  That curved/storage section is called the sigmoid. S for storage/sigmoid |
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 Then you get to the opening at the bottom where your poop leaves your body, called the anus |  The anus is a ring of muscles. This ring of muscles act as a valve, also called a sphincter. This sphincter prevents poop from falling out when you are not on the toilet. |
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 That can open |  And close |
 This valve, or sphincter, can "read" whether the contents are |  Liquid |
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 A solid |  Or gas |
 It can hold solids and gas but cannot hold liquids |  So that is why the body can not hold liquids |
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What happens in my body when I have constipation?
 When you don't poop well, poop starts building up in your large intestine |
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 So for example, when you have diarrhea, the valve cannot hold it in |
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So to summarize, when all works well, food waste, or poop, should not collect in the rectum all day long |
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So what happens during constipation?
 Constipation is when you do not poop well |  Remember the reasons for not pooping well may be different for everyone |
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When you have constipation your intestines can slowly clog up |  Which makes the sides stretch out |
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See if you can guess why |  The rectum stretches out more easily than the large intestine |
 The reason the rectum stretches out more easily |  Is because it does not have the constrictive bands like the large intestine have |
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Look, compare the top and the bottom part in this picture. It would be way easier to stretch out that bottom part if you would blow it up like a balloon |
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 So how do we blow up our rectum so that the poop ends up building up there? |
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 One reason | Is frequent straining, or pushing hard, to have a bowel movement |
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 Repetitive straining is like frequent pressure, just like blowing bubbles |  Especially when you do it over and over again |
 Another reason | Is when you postpone going to the toilet |
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 Starts stretching out the sides | The poops that sits there in the rectum, ready to go |
The stool becomes dry and backs up | Which requires you to strain again |
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Those hard poops can become almost the size of a soda can |  As the sides stretches out |
Anatomy: What is the answer to treating my constipation?
 The nerves of the walls of the rectum are being stretched out |  So the message that you "need to go" |
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 Does not reach your brain so well | It is almost like the sides of the rectum has gone numb a bit |
 This becomes a vicious cycle then of an overstretched, filledup with too much poop, not able to feel so much any more, rectum |  And you feeling miserable |
Anatomy: What is the answer to treating my constipation?
 Part of your treatment is to figure out why you have been having a hard time with pooping |  Then, most importantly, we must clear things out. Later in this guide we will explain to you how |
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 We clear things out so that we can keep things moving |  So that your rectum can stay empty most of the time like it should |
 And so that your rectum can shrink back to its normal size with time |
Anatomy: What happens during overflow leakage?
Tricktionary fact:
Facts about leakage and urge
You cannot 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. |
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 It's like how ice cubes can't stop water from moving around them. |
Why you can not feel the leakage:
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 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 the leakage |
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 Just like your body has gotten used to the smell. Everyone else can smell you, but you don't smell yourself anymore |
The reason you may not feel the urge to go anymore is:
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The reason you may not feel the urge to go anymore is:
Because your rectum... | Has been stretched out |
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 The nerves in your rectum... |  Are having a harder time connecting to each other |
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And now the nerves are having difficulty signaling an urge to you. |
Anatomy: What happens in my body when I have constipation, and my bladder is also leaking?
The reason some kids have urine leakage too |  Is because their stretched out rectum |
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 Is leaning against their bladder, irritating it. |
 So all kinds of bladder symptoms can happen | Because of constipation. |
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Full-pipe Cleaning Section
Trictionary Facts:
We have a constipation buster plan.
Before we start explaining the plan, we have to let you know:
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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. |
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 Especially in the beginning. |  The longer you have struggled with constipation, the longer it may take to retrain your body. |
 You may have to deal with relapses and failures for a while, which is normal |  Sometimes the constipation does go away by itself |
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But it is better to treat it |
But the plan requires courage!
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 It is quite hard to treat it, we know |  But just think of taking one step at a time |
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Our Constipation Buster Plan.
But wait!!
Trictionary Facts:
Researchers have found that improving bowel movements can be achieved by paying attention to how you sit and push.
A: First, learn how to sit on the toilet correctly.
 You are going to aim for this position |  First, find a box to use as a footstool. Place it in front of your toilet |
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 Sit on the toilet and place your feet on the box.Same position as this boy playing video games |  Place your feet and knees apart, and lean slightly forward with your back straight. Remember your feet are on the box |
 Next, relax your whole body, even your face and jaw |  Your knees should be higher than your hips |
B: Second, learn how your stomach should move when you bear down to have a bowel movement.
 When bearing down to have a bowel movement |  You want you stomach to move outward. We call it belly big, belly round |
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 Stomach pulling in example: You know when you lie in a hammock and your stomach pulls in when you look down? You do not want that movement when bearing down |  You do not want your stomach to pull in when you bear down |
 Bearing down to have a bowel movement |  Is a gradually push - like a plunger- from top to bottom. |
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 Which then results in your stomach going big and round |
 Your belly should be round, like a ball. Not hard as a rock - that is too much |  Your stomach should feel round and soft, like the body of this cat |
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 But wait! Before you start practicing belly big, belly hard |  We need to teach you something cool about words |
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C: Third, success with bearing down requires using the right words!
When you bear down |  You need to use the right words |
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 So that your body can know to use the right muscles |  And using the right words, will also help with belly round, belly big |
 When you bear down, 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 |
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D: Fourth, learn that the push should be short and slow. You do not want to strain
 Slow push, remember the plunger bearing down from top to bottom | You want to avoid straining. Straining means you are using force |
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And that force can further stretch out your rectum | With straining you are also not relaxing the muscles around your butt hole |
 Which means your bottom is working against what you are trying to do | Oh and make sure you do not sit on the toilet for more than 5 - 10 minutes. Sitting there too long can have a similar effect on your body as straining |
After you have done your slow bearing down while saying "dragon poo" and not strain |  Wait a bit |
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Did you know that when everything works well, the body should push the poo out all by itself? |  Give your body a chance and see if it can do it. And if not, then think of training your body. You and your body are both in this together |
 That wait will also help you relax and slow down |  You bowels work better when you are not in a hurry. Maybe sit there and SLOWLY count to five |
E: Five, learn to put it all together. Sit in the correct position, use belly big belly round, and bear down while saying "dragon poo"
Start off by sitting in the right position with your knees higher than your hips and feet on a box or footstool | Feet on footstool Feet flat Feet and knees apart Back straight Leaning forward |
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 Relax your whole body, including your face |  Now get ready to make belly big, belly round |
 Begin by doing a short "dragon poo" bearing down. And then wait! |  Wait for your body to do the rest on its own. And if your body does not push the poo out all by itself |
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 Then repeat the bearing down, saying "dragon poo". Only once or twice more. | And if your body still does not push the poo out by itself |
Then bear down a little more, or strain SLIGHTLY |  And keep reading till our medication section, because that is what will help you the most |
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Remember, straining is one of the things that stretches your rectum out, so you want to do it as little as possible |
F: Sixth, understand that this process is like retraining your body, and it may take time.
Remember, you are training your body to have new poop habits |  And learning every trick you can find to make your constipation better |
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 But I have a suggestion for you: | The training is hard and at times you will feel like you fail |
 Focus on the start - setting up your program |  Understand you training plan. Understand what constipation is, how you can treat it and who will be there to help you |
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 Then just focus on your training |  And celebrate every small win along the way |
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For example, I call a win |  When you feel like you can hide your body slightly less |
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 It may take weeks to months or even years for a few kids, before they get better. So just keep going. |  Because the results take a while, make following the program your goal instead of reaching the end goal |
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Drop In Suggestions
Before we continue, you need wiping tips!
 First you need supplies | So go get the help of a parent |
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 Second, make sure you have big pockets without holes in them, so you can carry your supplies around with you |
 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 |
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 Buy a dental tool mirror |  You can use the little mirror to make sure you wipe really well |
 Have your mom buy a butt 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 |
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 After you wiped, throw the bag with the wipes in the bin. No can see through the black bag, so you are good to go | Remember! Never flash wipes down the toilet! |
 Remember, even if you wear pull-ups, wear clean clothes every day - including shirt and socks |  Make sure you wash your hands really well afterward |
G. Seventh on Find a bowel routine.
 | Our bowels works best when it has its own special time during each day. |
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 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. |
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 Any kind of leg swings |  Karate kicks |
D. Focus on your stomach
 |  Start with at least one portion of vegetables and fruits a day. |
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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. |
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 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. |
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 Swing or hang if you can. |  Hang upside down. |
 Punching exercises are good for strengthening your belly. |  Go explore nature around where you live... |
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Flow Team Section
Your constipation coaching team:
What happens when you see your doctor?
First, the doctor investigates.
| First, the doctor will evaluate you, |
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 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. |
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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. |
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After the cleanout, your doctor may suggest a maintenance program:
| The maintenance program may include a few more cleanouts. |
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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. |
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 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. |
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 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, |
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 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. |
What if you and your body were seperate? |  What if you only do what you can do |
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 And you let your body figure out the rest |  And the two of you walk this path together |
It can also help to see a talk therapist, counselor, or anyone else helping kids deal with their constipation problem
 Every boy learn differently |  You may find it difficult to express what you need in words |
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 And to understand where you need help | This guide may help you with that |
 The more you understand your problem |
You
Matter
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