Pediatric Fecal Incontinence

To help diagnose fecal incontinence, we’ll first discuss your child’s symptoms and medical history. From there, we may perform several tests. The following tests can be used to determine the cause of fecal incontinence and to rule out other gastrointestinal conditions:

• Digital rectal exam (DRE). This checks for large, hard lumps of stool that are stuck in the colon or rectum.
• Abdominal x-ray. This confirms the presence of hard stool (impacted stool) inside the colon or anus.
• Barium enema. This is an x-ray that uses a liquid called barium to check the intestines for blockages, narrowing and other issues.
• Anorectal manometry. This measures how well the rectum and anal muscles work to discharge stool from the colon.
• Colonoscopy. This uses a thin tube with a camera to examine the inside of the colon and rectum.

Pediatric fecal incontinence is often caused by chronic constipation that’s brought on by:

• Refusing to poop (due to behavioral or emotional difficulties, stress, or stool withholding because passing stool is painful)
• Eating too little fiber
• Not drinking enough fluids
• Using certain medications, like iron supplements or antidepressants

Fecal incontinence can also be related to medical conditions like:

• Hirschsprung’s disease (condition that affects the large intestine)
• Anorectal malformations (birth defects of the anus and rectum)
• Spina bifida (birth defect of the spinal cord)
• Problems with the muscles around the anus and rectum
• Damaged nerves that help control bowel movements

Treatment for fecal incontinence depends on the cause and is tailored to your child’s age and personality. Some children may only require changes to their diet whereas others may require medications. The main goal is to make it easier to pass stool on a regular basis. In many cases, a combination of treatments and techniques are used to manage fecal incontinence. Possible treatments and techniques include:

• Medications like laxatives (stool softeners or stimulants), bowel cleanout or cleanses to help pass stool
• An enema, which is a liquid that’s injected into the rectum to clear out stool that is backed up (impacted)
• Dietary changes, like drinking water and eating foods that are high in fiber
• Toilet time after meals to encourage bowel movements
• Sensory training (biofeedback therapy) to help children learn to regulate and relax their bowel muscles
• Counseling to address emotional or behavioral issues that are causing soiling

We will work closely with you to develop the best approach to ease embarrassing symptoms and help your child develop good bowel control.