Fecal incontinence in children

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Última revisão: 10 Feb 2026

Última atualização: 09 Aug 2022

Fecal incontinence in children is defined as involuntary defecation at inappropriate times, occurring after the typical age of completed toilet training (generally 4 years of age or older).

In most cases, caused by overflow soiling associated with chronic constipation and severe fecal impaction in an otherwise healthy child without underlying anatomical abnormalities.

May have a significant negative impact on the quality of life for the child and the family.

A thorough history and physical examination are the crux of diagnosis. Laboratory and radiological studies may be used on a case-by-case basis to determine the underlying etiology.

The goal of therapy is for patients to pass stool 1 to 3 times per day in the toilet with no episodes of soiling.

Treatment involves complete colon disimpaction, long-term treatment with laxatives and stool softeners, and bowel re-education. Any underlying causes should also be addressed.

Definição

Fecal incontinence in children is the involuntary passage of stool from the rectum through the anus resulting in episodes of stooling at inappropriate times, occurring at an age after which toilet training is typically complete (in most, 4 years of age or older).

História e exame físico

Principais fatores diagnósticos

history of anorectal, neurologic, or spinal abnormalities, or gastrointestinal surgery
fecal soiling or diarrhea
constipation
perianal skin irritation
abnormal rectal examination
spinal deformities
weakness and decreased or absent reflexes

Detalhes completos

Outros fatores diagnósticos

behavior problems
painful bowel movements
abdominal pain/cramping
posturing described as tightening of buttocks
enuresis
anorectal malformation
abnormal abdominal examination
history of underlying medical condition

Detalhes completos

Fatores de risco

chronic constipation
male sex
age: 5 to 6 years
diet lacking in fiber
inadequate fluid intake
delayed or inadequate toilet training
anorectal malformations
Hirschsprung disease
spinal abnormalities
psychological or behavioral problems due to stressful family events
psychiatric disorders
medication overuse

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

abdominal x-ray

Detalhes completos

Investigações a serem consideradas

unprepared barium enema
spinal x-ray
MRI spine
radiopaque marker transit radiograph
colonic and rectal manometry studies
rectal biopsy
serum thyroid-stimulating hormone level
serum free thyroxine (T4) level
sweat chloride test
tissue transglutaminase IgA

Detalhes completos

Algoritmo de tratamento

AGUDA

with constipation and fecal impaction

without constipation

CONTÍNUA

fecal impaction resolved

Colaboradores

Autores

Brian D. Riedel, MD

Clinical Associate Professor of Pediatrics Emeritus

Pediatric Gastroenterology, Hepatology and Nutrition

West Virginia University School of Medicine

Morgantown

Declarações

BDR declares that he has no competing interests.

Agradecimentos

Dr Brian D. Riedel would like to gratefully acknowledge Dr Linda S. Nield and Dr Uwe Blecker, previous contributors to this topic.

Declarações

UB declares that he has no competing interests. LSN is an author of a reference cited in this topic.

Revisores

John C. Thomas, MD

Assistant Professor

Division of Pediatric Urology

Monroe Carell Jr. Children's Hospital at Vanderbilt

Nashville

Declarações

JCT declares that he has no competing interests.

David C. A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU

Consultant Paediatrics Gastroenterologist

Western Sussex Hospitals NHS Trust

Chichester

Honorary Consultant Paediatric Gastroenterologist

Royal Alexandra Children's Hospital

Brighton and Sussex University Hospitals

Brighton

Declarações

DCAC has received research grants, consultancy fees, and reimbursement of conference expenses from Norgine UK, the manufacturer of Movicol. He is the author of a systematic review of polyethylene glycol-based laxatives; convenor of the Paris Consensus on Constipation Terminology Group; and external advisor of the National Institute for Health and Care Excellence pediatric constipation guideline development group.

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Referências

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Principais artigos

Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016 May;150(6):1456-68. Resumo

Levitt MA, Pena A. Anorectal malformations. Orphanet J Rare Dis. 2007 Jul 26;2:33.Texto completo Resumo

Bongers ME, Tabbers MM, Benninga MA. Functional nonretentive fecal incontinence in children. J Pediatr Gastroenterol Nutr. 2007 Jan;44(1):5-13.Texto completo Resumo

Abrams P, Andersson KE, Apostolidis A, et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn. 2018 Sep;37(7):2271-2.Texto completo Resumo

Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):258-74.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Nonspecific toddler's diarrhea
- Irritable bowel syndrome (IBS) with alternating constipation and diarrhea
- Infectious diarrhea
Mais Diagnósticos diferenciais
Diretrizes
- Constipation
- Sixth International Consultation on Incontinence recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence
Mais Diretrizes
Folhetos informativos para os pacientes
Constipation in children
Mais Folhetos informativos para os pacientes
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Fecal incontinence in children

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

with constipation and fecal impaction

without constipation

fecal impaction resolved

Colaboradores

Autores

Brian D. Riedel, MD

Declarações

Agradecimentos

Declarações

Revisores

John C. Thomas, MD

Declarações

David C. A. Candy, MBBS, MSc, MD, FRCP, FRCPCH, FCU

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

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