Fecal incontinence in children

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 14 Aug 2025

最后更新： 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.

定义

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).

病史和体格检查

关键诊断因素

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

完整详情

其他诊断因素

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

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

abdominal x-ray

完整详情

需考虑的检查

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

完整详情

治疗流程

急症处理

with constipation and fecal impaction

without constipation

持续性治疗

fecal impaction resolved

撰稿人

作者

Brian D. Riedel, MD

Clinical Associate Professor of Pediatrics Emeritus

Pediatric Gastroenterology, Hepatology and Nutrition

West Virginia University School of Medicine

Morgantown

利益声明

BDR declares that he has no competing interests.

鸣谢

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

利益声明

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

同行评议者

John C. Thomas, MD

Assistant Professor

Division of Pediatric Urology

Monroe Carell Jr. Children's Hospital at Vanderbilt

Nashville

利益声明

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

Divulgaciones

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

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

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

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

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 Resumen

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 Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Nonspecific toddler's diarrhea
- Irritable bowel syndrome (IBS) with alternating constipation and diarrhea
- Infectious diarrhea
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Guías de práctica clínica
- Constipation
- Sixth International Consultation on Incontinence recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence
Más Guías de práctica clínica
Folletos para el paciente
Constipation in children
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Fecal incontinence in children

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

with constipation and fecal impaction

without constipation

fecal impaction resolved

撰稿人

作者

Brian D. Riedel, MD

利益声明

鸣谢

利益声明

同行评议者

John C. Thomas, MD

利益声明

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

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice