Pediatric fecal incontinence

What is pediatric fecal incontinence?

Pediatric fecal (or bowel) incontinence is the lack of bowel control, which means a child can’t control when they pass stool (poop). Health care providers diagnose fecal incontinence in children age 4 and older who are toilet trained but can’t control their stool or are unable to achieve toilet training.

Childhood bowel incontinence happens by accident – your child isn’t doing it on purpose. Children with fecal incontinence often pass stool in places other than a toilet, such as in their underwear. Stool accidents can be upsetting and embarrassing for you and your child, but treatment can help.

What are the different types of pediatric fecal incontinence?

The four main types of bowel incontinence in children include:

Urge fecal incontinence

This type of fecal incontinence causes a sudden, strong need to have a bowel movement. Often, the child can’t get to a toilet in time and has a stool accident.

Passive fecal incontinence

With passive fecal incontinence, a child has stool leaks without knowing it. The child’s body might not be able to sense when their rectum is full. The rectum is the last section of the large intestine.

Encopresis

This type happens in children who are toilet trained but have severe, chronic (long-term) constipation. Severe constipation causes hard, dry stools that become impacted (stuck) in the rectum. Encopresis is soft or liquid stool that overflows around the hard stool and leaks out of a child’s rectum.

Non-retentive fecal incontinence

Occurs in children age 4 and older who have regular bowel movements in inappropriate places or at inappropriate times, without an underlying medical cause or constipation. It affects about one in ten children with fecal incontinence. These children usually have daily bowel movements while awake and do not withhold stool. In some cases, emotional or behavioral issues like oppositional-defiant or conduct disorders may trigger soiling episodes, which often happen in response to certain people or situations.

What are the signs and symptoms of pediatric fecal incontinence?

The signs and symptoms of fecal incontinence in kids include:

• Strong, sudden urge to have a bowel movement

• Stool leaks without knowing it

• Stool accidents ranging from small amounts to complete bowel movements

• Stool accidents that happen after a long time without accidents

• Constipation

• Diarrhea

• Abdominal (belly) pain

• Gas and bloating

How is pediatric fecal incontinence diagnosed?

Your child’s primary care provider may diagnose fecal incontinence and refer you to Children’s Health for further evaluation and treatment. At Children’s Health, our pediatric gastroenterologists (specialists in conditions affecting the digestive system) do a thorough evaluation.

We begin with a physical exam, and we’ll ask you about your child’s symptoms and family medical history. We’ll also ask if your child has had any injuries or a congenital (present at birth) condition that may lead to childhood bowel incontinence.

To confirm a diagnosis, we may do different tests, including:

• Digital rectal exam (DRE): Our doctors use their finger to check for impacted (stuck) stool in the colon or rectum.

• Abdominal (belly) X-ray: An X-ray test uses small, safe doses of radiation to get pictures inside the body. We use abdominal X-rays to look for impacted stool.

• Contrast enema: An enema is a liquid solution that doctors inject through the anus (end of the rectum where poop comes out). A contrast enema uses a liquid that shows up in X-rays. We use this to check the intestines for blockages, narrowing and other issues.

• Anorectal manometry: We insert a narrow, flexible tube with sensors into the rectum to measure how well the rectum and anal muscles work.

• Radiopaque marker test: A test that involves taking a capsule with small medical-grade rings and obtaining an abdominal X-ray five days later to assess colonic transit and understand if incontinence is coming from encopresis.

• Colonoscopy: We insert a narrow, flexible tube with a camera through the rectum to view the entire large intestine.

What causes pediatric fecal incontinence?

The causes of bowel incontinence in a child differ from those in adults. The causes include:

• Constipation

• Diarrhea

• Congenital conditions that affect the intestines or other pelvic organs, such as Hirschsprung’s disease, anorectal malformations and cloacal malformations

• Congenital conditions that affect the spinal cord and nerves that control bowel movements, such as spina bifida

• Certain behavioral conditions

How is pediatric fecal incontinence treated?

At Children’s Health, your child receives care from nationally ranked pediatric gastroenterologists, surgeons and advanced practice providers. The treatment options for fecal incontinence in children depend on the cause. Our team creates a treatment plan specifically for your child, with one or more options tailored to their needs.

Our treatment options for childhood bowel incontinence include:

• Medication: We may prescribe laxatives or other medications to help your child pass stool more easily.

• Enemas: These liquid solutions can help clear out impacted stool and relieve constipation.

• Counseling: Our child psychologists can help your child manage emotional or behavioral issues that might be related to fecal incontinence.

• Dietary changes: Constipation is a common cause of fecal incontinence. Healthy habits such as drinking more water and eating high-fiber foods can help relieve constipation.

• Sensory training (anorectal biofeedback therapy): This treatment helps children better use their muscles to control bowel movements. Doctors attach sensors to muscles in their belly and anus. The sensors connect to screens that show what happens when they tense and relax certain muscles. Children learn how it feels to use those muscles. Then they practice doing those actions to hold stool in and push it out.

• MACE or cecostomy: These surgeries connect part of the large intestine to an opening in the child’s belly. They make it easier for children or their parents to do enemas. MACE and cecostomy may be an option for children who need regular enemas.

• Pelvic floor physical therapy: This type of therapy focuses on strengthening muscles in the pelvic floor, which supports the bladder, uterus and rectum.