Hey ,

Did you know you can get a detailed list of all your activities on CEO if you wanted to capture your self-directed learning for CEU/CPD records? Just head over to > https://ceo.wiredon.ltd/account/activity

And whilst you're there check out this great CEO session with Dawn addressing constipation and fecal leaks in a 5-year-old girl with history of early toilet training:

Patient Presentation and Main Concerns

• 5-year-old girl with history of early toilet training
• Recent onset of fecal leaks and accidents
• History of allergies and eczema
• Dysregulated behavior coinciding with onset of accidents
• Mother concerned about self-esteem impacts

Assessment Tools and Techniques

• Visual postural assessment
• Bristol Stool Scale
• Observation of breathing patterns
• Evaluation of rib cage angle and diaphragm descent

Intervention Strategies and Practical Techniques

• Bowel clean-out followed by maintenance program
• Miralax titration based on stool consistency
• Hydration monitoring and encouragementClear water bottle with measurement markings
• "Drink this much before first recess, this much by lunchtime..."
• Diet modificationsReduce bladder irritants (carbonation, citrus, caffeine)
• Increase fruits and vegetables intake
• Normalize accidents

Clinical Pearls and Actionable Recommendations

• 47% of children with daily normal bowel movements are still constipated
• Fecal leaks indicate impaction, even with normal-appearing stools
• Clean-out should be followed by consistent daily maintenance
• Never abruptly stop medication - titrate down slowly
• Aim for Type 4 or 5 on Bristol Stool Scale during maintenance
• Maintenance may be needed for 3+ months as rectum returns to normal size
• Hydration goal: half body weight in ounces daily
• Fruit/vegetable serving size: what fits in child's hand

Surprising Observations or Unique Aspects

• Early toilet training may contribute to later issues
• Postural compensations can indicate constipation
• Rib flare and hyperextension related to constipation and pressure system dysfunction
• Bladder leaks often precede fecal leaks in chronic constipation

Resources or Tools Referenced

• International Children's Continence Society guidelines
• Bristol Stool Scale
• Motivational water bottles with smartphone connectivity
• Clear water bottles with fruit infusers for flavor

Things to Remember

• Fecal leaks indicate chronic constipation
• The bowel is very sensitive and takes months to regulate so consistency is key.
• A bowel cleanout is needed at the onset to treat chronic constipation
• Using positive non blaming language for "accidents": Bowel and bladder leaks.

+ much, much more...

▶ Play

Sit down and be inspired!

Warm regards,

Mindy

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