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Fecal incontinence in children

Last reviewed: 1 Nov 2023
Last updated: 09 Aug 2022



History and exam

Key diagnostic factors

  • 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
More key diagnostic factors

Other diagnostic factors

  • 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
Other diagnostic factors

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • abdominal x-ray
More 1st investigations to order

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
More investigations to consider

Treatment algorithm


with constipation and fecal impaction

without constipation


fecal impaction resolved



Brian D. Riedel, MD

Clinical Associate Professor of Pediatrics Emeritus

Pediatric Gastroenterology, Hepatology and Nutrition

West Virginia University School of Medicine




BDR declares that he has no competing interests.


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


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

Peer reviewers

John C. Thomas, MD

Assistant Professor

Division of Pediatric Urology

Monroe Carell Jr. Children's Hospital at Vanderbilt




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


Honorary Consultant Paediatric Gastroenterologist

Royal Alexandra Children's Hospital

Brighton and Sussex University Hospitals




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.

  • Fecal incontinence in children images
  • Differentials

    • Nonspecific toddler's diarrhea
    • Irritable bowel syndrome (IBS) with alternating constipation and diarrhea
    • Infectious diarrhea
    More Differentials
  • Guidelines

    • Constipation
    • Sixth International Consultation on Incontinence recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence
    More Guidelines
  • Patient leaflets

    Constipation in children

    More Patient leaflets
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