It’s a topic that few parents want to talk about, let alone admit that their child has a problem with. However, fecal soiling in children is surprisingly common. Oftentimes, it negatively impacts the child’s self-esteem and social acceptance and can strain family dynamics. However, whenever a proper evaluation is made and a treatment plan is put into place, most kids can overcome these problems and go back to just being a kid.
Whenever I see a child with uncontrolled fecal soiling, the first question that must be answered is whether the problem is soiling or true fecal incontinence. While soiling is often due to a separate health problem that can be treated, incontinence means a child does not have the normal mechanisms to control bowel movements.
Fixing Fecal Soiling
Soiling can affect children born with congenital colorectal abnormalities or spinal cord problems, such as spina bifida. More often, however, it affects kids suffering from severe constipation, which is also known as encopresis.
Children with encopresis experience “accidents,” or uncontrollable soiling, because they are so backed up (impacted) that it escapes in small amounts. Many times, parents are unaware that their child is constipated and think it’s a behavioral issue. They often assume their child isn’t taking the time to make it to the toilet or is just not properly cleaning up afterward. But in reality, kids with encopresis are not able to control these episodes and usually aren’t even aware they occurred.
For kids with encopresis, successful treatment of the constipation usually solves the problem. This may be easier said than done, and it takes time and patience. Normally, constipation can be fixed through a prescribed program aimed at regulating the colon, which is done by closely monitoring diet and supplementing with medicine as needed. Sometimes, children may require a focused motility evaluation — a study of how food and waste moves through their system — including colonic and anorectal manometry diagnostics. Very rarely, surgery is needed to remove the non-working parts of the colon.
True Fecal Incontinence
Kids who were born with colorectal problems, such as anorectal malformations, hirschsprung disease and those with spinal problems, sometimes lack the physical parts or mechanisms to control their bowels. These kids may have true fecal incontinence.
Children with true fecal incontinence need to follow a daily regimen to prevent uncontrolled bowel movements. A custom enema program works to empty the colon once a day so that the child can remain clean for the rest of the day. For children with incontinence, laxatives and other medicines do not work well and can even make the situation worse, since such drugs can cause more accidents. Recent medical enhancements have offered hope to these kids. For example, techniques such as sacral nerve stimulation (SNS) can sometimes offer just enough control for a child to gain continence.
Dr. Levitt received his undergraduate degree from the University of Pennsylvania and his medical degree from the Albert Einstein College of Medicine. He completed his general surgery residency at Mount Sinai Medical Center.
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