When we are doing a "clean out" by increasing the laxative dose as you describe in your book, how do we know the stool has been sufficiently cleaned out to reduce the laxative dosage?
As part of their initial assessment, some healthcare providers will obtain what is called a lower abdominal x-ray to determine if there is excess stool anywhere in the large intestine. If this was done, a second post-cleanout x-ray can help determine whether the cleanout was successful.
When x-rays have not been done, which is typically the case, the answer to this question is based on the quantity and the consistency of the stool that was moved during the 3-4 day cleanout, compared to the amount and consistency of stool moved in the 3-4 day period prior to the cleanout. Ideally, in about two to four days, the higher dose of a laxative will enable the child to produce considerably more stool than in the days prior to the cleanout, and the consistency of the stool will become very loose or watery.
At this point we assume that the rectum has been cleaned out and we gradually begin to lower the dose of the laxative until the stool consistency becomes more like apple sauce or pudding. Once this has been accomplished, you then continue on into Step #3 of my Six-Step Program which is to "End Withholding."