Urotherapy Book

20 Polyethylene glycol is administered orally but its drawback is that it needs to be given for at least four days in a row and increases the risk of faecal leakage during treatment. This treatment could be repeated if constipation and/or faecal leakage come back. This is not uncommon in the beginning of the treatment.  Maintenance treatment The maintenance dose of Polyethylene glycol is smaller than what is given in the disimpaction regime. The dose needs to be sufficient to make the stool soft and there are individual differences in how big the ideal dose is. The family can use the Bristol stool scale to monitor the correct dose for their child. The goal of the treatment is that the child shall have soft poo daily or every other day. Polyethylene glycol shall be mixed with the correct amount of water and works by retaining the water in the colon. If the child has difficulties taking Polyethylene glycol it could be mixed with lemonade or juice. It can be taken in the morning or evening.  The family needs to be observant of relapses in the treatment. Signs of this can be faecal leakage or infrequent defecation. When this happens, the parents need to treat with either enema for 1-2 days or increase the dose of Macrogol for 2-3 days to make the treatment work again.  The treatment with Polyethylene glycol needs to be continued for at least 3-6 months and in many cases longer. The child needs to have a regular bowel habit without holding behaviour for a couple of months before the Polyethylene glycol dose can be lowered and finally ended. If there are recurrent problems with faecal leakage or the child starts to poop infrequently, the treatment needs to start again.  Urotherapeutic interventions  The third part of treatment is regular toilet visits after meals 1-3 times a day. This is to use the gastrocolic reflex and establish good bowel habits. Sitting 5-10 minutes after food increases the chance of passing stool regularly.