Fecal incontinence in children

What is fecal (bowel) incontinence in children?

Pediatric fecal incontinence is when a child who is toilet-trained (usually older than four) can’t control when and where they poop. This means they accidentally poop before they can reach the toilet.

Fecal incontinence is also known as bowel incontinence, soiling or encopresis.

It can be very embarrassing for children and is usually caused by chronic constipation or a medical condition that impacts the colon.

What are the signs and symptoms of fecal (bowel) incontinence in children?

• Inability to control bowel movements
• Passing small amounts of liquid stool
• Constipation
• Tummy pain

How is fecal (bowel) incontinence in children diagnosed?

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.

What causes fecal (bowel) incontinence in children?

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

Anorectal malformations

Spina bifida

Problems with the muscles around the anus and rectum

Damaged nerves that help control bowel movements

How is fecal (bowel) incontinence in children treated?

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

Medications like laxatives (stool softeners or stimulants), bowel cleanout or cleanses to help pass stool

Enema

An enema, which is a liquid that’s injected into the rectum to clear out stool that is backed up (impacted)

Dietary changes

Dietary changes, like drinking water and eating foods that are high in fiber

Toilet time

Toilet time after meals to encourage bowel movements

Sensory training

Sensory training (biofeedback therapy) to help children learn to regulate and relax their bowel muscles

Counseling

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.