Faecal incontinence in children

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 18 Aug 2025

Last updated: 09 Aug 2022

Faecal 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 faecal 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 aetiology.

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.

Definition

Faecal 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).

History and exam

Key diagnostic factors

history of anorectal, neurological, or spinal abnormalities, or gastrointestinal surgery
faecal soiling or diarrhoea
constipation
peri-anal skin irritation
abnormal rectal examination
spinal deformities
weakness and decreased or absent reflexes

Full details

Other diagnostic factors

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

Full details

Risk factors

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

Full details

Diagnostic investigations

1st investigations to order

abdominal x-ray

Full details

Investigations to consider

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

Full details

Treatment algorithm

ACUTE

with constipation and faecal impaction

without constipation

ONGOING

faecal impaction resolved

Contributors

Authors

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 paediatric 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.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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

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
- Non-specific toddler's diarrhoea
- Irritable bowel syndrome (IBS) with alternating constipation and diarrhoea
- Infectious diarrhoea
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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Faecal incontinence in children

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

with constipation and faecal impaction

without constipation

faecal impaction resolved

Contributors

Authors

Brian D. Riedel, MD

Declarações

Agradecimentos

Declarações

Revisores

John C. Thomas, MD

Declarações

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

Declarações

Peer reviewer acknowledgements

Disclosures

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

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice