Objective: To implement and to evaluate the effectiveness of the Uniformed Services Constipation Action Plan (USCAP) in our gastroenterology clinic for children with functional constipation.
Study design: This implementation science study included toilet-trained subjects aged 4 years and older who met the Rome IV criteria for functional constipation. Children were block randomized to receive either the USCAP or control. All clinic functional constipation plans recommended subjects continue pharmacotherapy for 4 months. Endpoints measured were clinical outcomes (resolution of functional constipation and achievement of a Pediatric Bristol Stool Form Scale [PBSFS] score of 3 or 4), patient-related outcomes (health-related quality of life [HRQoL] total scale score), and health confidence outcomes (Health Confidence Score [HCS]).
Results: Fifty-seven treatment group subjects (44%) received a USCAP (52% male; mean age, 10.9 [4.9] years) compared with 73 controls (56%; 48% male; mean age,10.9 [5.3] years). A PBSFS score of 3 or 4 was achieved by 77% of the treatment group compared with 59% of controls (P = .03). Subjects from the treatment group were more likely than the controls to endorse adherence to the 4-month course of pharmacotherapy (P < .001). Subjects who received a USCAP had greater improvements in HRQoL total scale score by the end of the project (P = .04).
Conclusions: The USCAP is a simple, inexpensive tool that has the potential to improve global outcomes for functional constipation in children and should be recommended as standard clinical practice.
To see the Vermont Continence Project’s “Constipation Traffic Lights Form and a plain language video describing its use, go to Constipation Treatment: Bowel Maintenance
Did you know that 40-50% children treated for constipation will have a relapse in the first 1-5 years? We encourage parents to do what you can to prevent relapses, but also to prepare yourself for what might happen. This video from Vermont Continence Project nurse consultant, Kelly Savitri, RN, offers helpful suggestions to keep things moving smoothly.
We might think of “toilet training” as one activity, but it’s actually made of lots of separate steps and skills! This video can help you figure out where to focus your attention and support your child with the skills they are working on right now.
Most of us have heard the suggestion to create a schedule for your child to sit on the toilet. Most of us don’t get much advice about when, how often, or how to make it work with your busy family life. Check out this video for hints on how to create and implement a sitting schedule.
Let’s talk about building your toilet time toolbox! There are lots of things you might want to have in the bathroom to make toileting more successful and enjoyable for you and your child.
Building your toileting toolbox is also a great activity to do with your child to prepare for a sitting schedule.
If your child attends school, you may be wondering how to collaborate with your child’s school team to support their continence. This video gives some of the highlights from our guide, Best Practices in School-Based Toilet-Learning & Continence, which is below.
Popular toilet “training” models give the impression that many children can go from diapers to full continence independence in a few days. This is not the experience of many parents. This video explains the phases of the toilet teaching process, and can help you identify the right kinds of support to provide at different times in the toilet teaching journey.
Many providers suggest that children sit on a regular schedule, but not every body needs the same schedule! This video explains how to know how often, and when, your child needs scheduled sits.
Hi, my name is Chayah Lichtig. I’m the director of the Vermont Continence Project and I’m a licensed occupational therapist. In this video, we are going to talk about taking bowel data to support continence.
So parents often wonder, what’s the purpose of taking this data? We’ll start with the fact bowel issues are the number one underlying cause of incontinence in kids. This is true for kids with disabilities and kids without. It’s true for kids who were continence and loss skills and for kids who have never been continent. It’s even true for kids who only have urine incontinence and no identified bowel issues. So we want to have concrete information about our child child’s bowel habits to support our conversations with our child’s physician school team and your child themselves.
So let’s start with something called the Bristol Stool chart. On the next slide, I’m going to share a picture of a one through seven scale that describes the consistency of stool. Doctors like it because it’s well agreed on. It’s easy to understand and it has some pretty clear visual representations. This is a picture of the Bristol Stool chart.
You will see that the numbers get higher as you go along. A lower number means a drier, harder stool consistency, and a higher number means a wetter, looser stool consistency. Let’s go through the seven numbers in order.
Type one is separate hard lumps. They may be difficult to pass or they may fall out.
Type two is sausage shaped, but dry and lumpy.
Type three is like a sausage, but with cracks on the surface.
Type four is super smooth and soft, like a snake or sausage.
Type five is soft blobs with clear edges. They pass easily.
Type six is fluffy, ragged pieces with soft edges almost liquidy.
And type seven is watery. No solid pieces entirely liquidy.
As you may have already learned from watching videos from our nurse consultant Kelly, you will know that numbers one and two are very strong signs of constipation. Numbers six and seven can also be common signs of constipation. Or they can be signs of other GI problems as well. The Bristol stool scale is a very important piece of data which your child’s doctor will probably ask about, but it’s also helpful to keep track of these other factors.
Frequency. One of the official criteria for constipation is how often your child has a complete bowel movement. Loss of small amounts of stool is not the same as a complete bowel movement. But you’ll also want to know and take track of how often they have small streaks, smears or pebbles size. Note If your child has very small or very large BMs regularly or on occasion, these can be signs that the muscles aren’t working well to push out through shape.
Are your child’s stools shaped like logs or balls? A ball shaped stool means that your child’s colon is very stretched out, allowing stool to collect in a lump rather than squeezed into a tight tube.
Mixed consistency. Does your child have BMs that are dry and hard like a two or three one day and a number six the next day? Or can you see a mix of consistencies in a single BM? These are also signs that GI function is not as smooth and consistent as it could be, and that things are not moving along as we might hope and expect.
Finally, if you are giving any medication at this time for your child’s GI system, please make a note of when and how much you give.
Parents often ask how long to take data That depends on how often your child is struggling and how much you know about their system. If your child has a BM every single day, not just a smear, 5 to 7 days of data is probably enough. If your child has very irregular stool patterns or goes infrequently, try to take data on at least seven complete bowel movements.
Many parents find, however, that once they start paying closer attention to their child’s stool habits, that they notice some of the concerns we’ve mentioned and they seek the support of their child’s PCP sooner. Overall, the goal is to get a clear picture of how your child’s system is working right now so you can make the right choices to help them.
How to take Data: In the resources connected to this video, we have a data sheet that you can use. It has a key that reminds you of all the points that I’ve mentioned in the previous slide. You are encouraged to print that out and use it. You can also use any notebook and pencil or the notes app on your phone or tablet. We find people are most likely to take data when they make it as easy as possible. So we suggest keeping that notebook or data sheet and a pen in whatever location your changing undergarments or disposing of stool.
Some parents don’t know what’s going on with their children’s bowel habits because some children change or use the toilet independently or they don’t want to talk about their stool habits. That’s okay. Some children can take their own data using our existing sheets. We’ve also included a simplified version of our data sheet where kids can circle the poo that looks the most like theirs. We find that children who are having accidents are really motivated to do something that is scientifically proven to help. With the right support, they’re often willing to try things that might feel sort of awkward or embarrassing. Explain to your child that most pee and poop accidents come from problems with poop and that this is the first step of treatment.
Thank you so much for taking the time to watch this video. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care professional.