Functional Constipation (FC) is a common complaint for which pediatric patients present for medical management. Existing research shows a greater prevalence of FC in the overweight pediatric population. Lifestyle modification is showing inconsistent results. One conservative strategy with sparse information is that of defecation posture modification. Objectives: The purpose of this investigation is to explore the effect of an educational intervention, including DPM, on the bowel elimination patterns of overweight and obese adolescents using a mixed-method approach. Study Design: Concurrent Embedded Mixed Methods. Methods: One hundred eighty-nine overweight/ obese adolescents ranging in age from 9 to 18 years attending a lifestyle modification camp participated in this study. Data collection consisted of completion of a series of Rome IV questionnaires along with a collection of a Bristol Stool Form Scale stool diary at multiple points during the camp for all subjects along with a questionnaire exploring the intention to use DPM outside of the study environment. The experimental group received the educational intervention, including instruction in defecation posture modification (DPM) followed by an opportunity to use the technique while still at camp. Two focus groups and eight individual interviews were conducted with members of the experimental group, during the final week of camp, for qualitative data. Three additional questions were added to the final experimental group survey to further clarify qualitative findings. Result: Control group N=55; Experimental grou N=64. No changes reached significance in the control group, but the improvement was noted in increased bowel movement frequency, reduced reports of incomplete emptying, and reduced FC rate. However, there was a recorded increase in reported straining. Experimental group findings showed the same pattern with statistical significance reached with improvements noted in bowel frequency and worsening in reported of straining. Results on FC prevalence in the population were varied with Rome IV showing FC prevalence within normal limits, but BSFS straining and incomplete emptying reports creating a statistically signficant elevated FC prevalence. Statistical significance was also reached when evaluating the subjects’ intention to use DPM upon returning home from camp with the experimental group showing a greater intention. Qualitative reports demonstrated significant benefits with the DPM specifically the report of faster and easier bowel movements. The main barriers identified were those of DPM discomfort and feelings of embarrassment or awkwardness with use. Conclusion: Quantitative results demonstrate modest support for the effectiveness of the educational intervention on positively impacting bowel movement quality in this population, specifically with regards to reduced evidence of delaying bowel movements and recognizing straining. Qualitative results demonstrate that DPM holds a promise as a helpful intervention in managing FC symptoms and potentially prevention of FC relapses. One-on-one patient/family instruction has a strong likelihood to solicit compliance with this technique at home without adding significant additional family burden. Additional research into the effectiveness of DPM as a tool for the management of FC needs to be performed so that DPM can be considered for addition to clinical practice guidelines for FC. Rome IV needs to be further evaluated for its sensitivity to readilty identify FC.
