Urotherapy Book

22  Modification When deciding on the treatment plan it is important to assess the family’s abilities to adhere to the plan. Can the family handle enemas, give the child Macrogol regularly and have regular toilet visits after meals? 14 If the parents are divorced; how is the relationship between the parents and how are the arrangements for the child decided? Who has the custody? How much time the child spends with each parent? If the parents have poor communication, the information must be given to the other parent who might not attend the visit to the clinic. If there is a concern for the child’s wellbeing because of the conflict between the parents, social services may be involved to help the family. Do the schoolteachers need to be involved in the treatment? It is hard in most cases to make toilet visits during schooltime but if the faecal leakage occurs during school that might be needed. Teachers need to be informed so that they can help the child change clothes in case of leakage.  Evaluation (adjust treatment plan) Contact and support with the family after the initial appointment is vital to control how the treatment is going. There is a risk that because of the tough treatment, the family don’t do it as planned. By contact through telephone or video the family gets support and encouragement to continue the treatment. On an outpatient clinic visit, the reassessment of symptoms gives a clue on how the treatment is working. Use the Rome IV criteria again and see if there are any changes for the better. If successful, ultrasound assessment of the rectum should reveal an