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.
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).
History and exam
Key diagnostic factors
- history of anorectal, neurologic, or spinal abnormalities, or gastrointestinal surgery
- fecal soiling or diarrhea
- perianal skin irritation
- abnormal rectal examination
- spinal deformities
- weakness and decreased or absent reflexes
Other diagnostic factors
- behavior problems
- painful bowel movements
- abdominal pain/cramping
- posturing described as tightening of buttocks
- anorectal malformation
- abnormal abdominal examination
- history of underlying medical condition
- 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
1st investigations to order
- abdominal x-ray
Investigations to consider
- 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
with constipation and fecal impaction
fecal impaction resolved
- Nonspecific toddler's diarrhea
- Irritable bowel syndrome (IBS) with alternating constipation and diarrhea
- Infectious diarrhea
- Sixth International Consultation on Incontinence recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence
Constipation in childrenMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer