Fecal incontinence (accidentally having bowel movements) is a very common problem in children. It can be caused by medical conditions like chronic constipation or congenital (happening before birth) conditions like spina bifida, anorectal malformations or Hirschsprung disease that may disrupt normal bowel control. Fecal soiling can cause children intense embarrassment and social problems, and it can be frustrating for both parents and children. The good news is that with patience, encouragement and the right treatment, most children can develop good bowel control and live normal lives.
1. True fecal incontinence occurs in children who do not have the normal mechanisms needed for controlling their bowel movements. Typically, these children have anorectal malformations (imperforate anus), Hirschsprung disease or spinal problems that prevented their bodies from developing normal bowel structures or control of those structures. While surgical repair can help restore bowel function for children with anorectal malformations and Hirschsprung disease, it cannot always insure bowel control. Children with true fecal incontinence can also be classified as having a slow or fast bowel – and the treatment for each is different. Through a bowel management bootcamp, or rarely, surgery, children with true fecal incontinence can successfully manage bowel movements and avoid soiling. Click here for more information about true fecal incontinence and how it is treated.
2. Pseudoincontinence or encopresis typically occurs in children with the ability to toilet train but who have developed severe, chronic constipation, which leads to stools that are infrequent or hard to pass. It can also occur in children with anatomical abnormalities that predispose them to developing constipation. While most of these children have the ability to control their bowel movements, they become so constipated that stool impacts and then overflows. Treatment is focused on preventing constipation and can be done through diet and medications. In some cases a bowel management program can be used to identify the correct medication dosage, and rarely, in very severe cases, surgery may be needed to help normalize bowel function and help prevent soiling.
There is also a promising new therapeutic modality for pediatric urinary and fecal incontinence, and chronic constipation in children when all other treatments have been unsuccessful. Sacral nerve stimulation (SNS) technology can be compared to a pacemaker for the heart, but instead, it provides stimulation to the anal canal area and lower part of the colon and the bladder.
While a few other children’s hospitals in the United States offer sacral nerve stimulation based on subjective criteria and clinical symptoms, Nationwide Children’s is one of the first to formally structure this therapy by evaluating objective bladder and bowel function studies before and after the procedure to assess treatment response. To learn more about Sacral nerve stimulation click here.
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