Types and Treatments of Fecal Incontinence :: Nationwide Children's Hospital

Types and Treatment

Children with true fecal incontinence lack the ability to voluntarily have a bowel movement, so they require daily interventions to empty the colon of stool. However, there are two different types of true fecal incontinence and treatment for each varies:

  • Children with a slow colon with constipation. This group represents the majority of children with true fecal incontinence and are usually those with anorectal malformations, Hirschsprung disease or patients with spinal disorders. They will require a daily enema that cleans the colon (see below), but many children won’t need a special diet or medicines.  
  • Children with a fast colon and loose stools. Loose stools can be a problem with some children who have had anorectal surgery and can also occur in some patients with Hirchsprung disease.  In addition to a daily enema, these children will also need a constipating diet, and medicine to slow the colon.

Physicians are usually able to predict which children with these issues will go on to have fecal incontinence so that parents can set expectations for potty training.  In some cases, parents are asked to try typical potty training around the age of three, and if that isn’t successful, the child can begin a bowel training bootcamp.  Depending on the child’s prognosis, potty training can be tried again during vacation or summer breaks to assess bowel control.  Usually, as a child with true fecal incontinence ages, they will become more engaged with managing their condition, and treatment plans will evolve.

Treatment Plans to Manage Bowel Control

Bowel management programs are tailored for each individual child and often require trial and error to determine which combination of interventions, diets and medications will work best.

  • Enemas: The typical approach is to use an enema to empty the colon and to train the bowel to stay “quiet” in between enemas. An enema involves inserting a tube into the rectum, and flushing out the stool with a prescribed solution, usually made from water and saline. The enema can be administered rectally, or a surgical procedure can be done to allow the enema to be given from the top of the colon down.

    The procedure, called a Malone appendicostomy is sometimes preferred by older children because it allows them to perform the enema by themselves. By completing the bowel training program and choosing the right enema, the child can usually stay clean and wear normal underwear. Enemas and laxatives (a medicine that makes stool move through the colon quicker) are never used together because that could cause an accident in between enemas. Children with little or no potential for bowel control will need to use enemas for the rest of their lives.
  • Diet: Loose bowel movements should be avoided, and a constipating diet can help. If the child soils after eating a newly introduced food, that food should be excluded from the diet.
Food to encourage Foods to avoid (that loosen bowels)
 Banana  Dairy products (milk, cheese)
 White Bread, bagels  Fried and oily foods (French fries)
 White pastas without sauce, rice  Sugar
 Boiled, baked, broiled meats (chicken, fish)  Chocolate
 Apples without skin, applesauce  Spices
 Water soluble fiber (pectin)  Fruits, Fruit Juices
 Tea and Soft Drinks (with artificial
 Jelly (no jam)    
  • Medications: Loperamide may be given to help slow down the colon. Physicians will work to gradually reduce the dose of medications to identify the lowest amount needed to keep the child clean for 24 hours. In a few cases, if a child with some capacity for bowel control has been successful with diet and enemas, they may be able to try a “laxative trial.”  This is just like the bowel training program, but instead of using enemas, the child uses laxatives to prompt bowel movements. Just like the enema bowel training program, the healthcare team will use daily abdominal x-rays to help establish if the laxatives are working and tailor a dose that might allow the child to eliminate the need for enemas.
  • Surgery: For some children who have had surgery to correct an anorectal malformation, a repeat procedure may help improve their potential for bowel control. For certain patients who have borderline bowel control, a new technology called sacral nerve stimulation (SNS) may eliminate the need for enemas. SNS uses a device to send a small electrical signal to help modulate nerves that control continence.

Contact the Colorectal Center

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000