Fecal incontinence in children

Last reviewed: 1 Sep 2022
Last updated: 09 Aug 2022

Summary

Definition

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

ACUTE

with constipation and fecal impaction

without constipation

ONGOING

fecal 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

WV

Disclosures

BDR declares that he has no competing interests.

Acknowledgements

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

Disclosures

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

Nashville

TN

Disclosures

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

UK

Disclosures

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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