Fecal incontinence is a serious problem in children. It can be caused by chronic constipation or by diseases that can disrupt bowel control such as spina bifida, Hirschsprung’s disease, rectal abnormalities, etc.
This symptom can cause embarrassment and social problems for a child, and can significantly impact the whole family.
TYPES OF INCONTINENCE
1) True fecal incontinence occurs in children who do not have the normal mechanisms needed to control bowel movements. Usually, these children have rectal abnormalities, Hirschsprung’s disease (congenital colorectal disease), and/or spinal problems resulting in the brain not receiving the message when the rectum is full of stool. Surgical management in patients that do not have the necessary underlying mechanisms of continence may help improve bowel function but cannot always ensure continence of stool.
Bowel problems can also be triggered by the speed at which the colon pushes the stool to the rectum (motility) before it reaches the sphincter muscles. Children with true bowel incontinence can also be classified as having a slow or fast bowel motility, and the treatment differs between the two.
Slow-hypomotile bowel: In patients where the colon pushes the stool slowly, the stool passes more time in the colon which absorbs its liquid making it harder and predisposes it to accumulate in the rectum – which is often larger than normal in most of these patients. These children may not be able to feel that their rectum is full, develop severe constipation, and then have accidents due to overflow.
Fast-hypermotile bowel: Patients who may have underlying fast bowel motility or have undergone surgery (in particular a bowel resection) tend to have loose or liquid stools that may leak from the anus.
2) Overflow incontinence or “pseudo-incontinence” usually occurs in children with normal sphincter control and the ability to toilet train who over the years have developed severe chronic constipation. This leads to faecal retention, a dilated rectum and often and overflow of stool causing accidents .
Incontinence of stool can be a serious problem for a child, the parent, and often the whole family. It is often a barrier to social acceptance, which in turn can lead to long-term psychological difficulties. To treat fecal incontinence it is important to understand the possible causes.
First of all, the child must have a medical evaluation to determine which of the 3 categories of incontinence they belong to. Pseudo-incontinence, true stool incontinence with diarrhea, or true stool incontinence with constipation. Once the true cause of fecal incontinence has been determined, treatment can be carefully adjusted to meet the child’s needs.
With the BOWEL MANAGEMENT PROGRAM
we can achieve normal bowel movements without accidents and achieve a good quality of life of child and family. The treatment is individualized for each patient and focuses on the prevention and treatment of constipation. This can be done through regulation of diet, with appropriate medication, enemas, physiotherapy of the pelvic muscles, but also psychological support.
However, the treatment of pseudo-incontinence, true fecal incontinence with diarrhea and true fecal incontinence with constipation is different.
We emphasize that with patients, encouragement, and correct treatment, most children can achieve good bowel function and live a normal life.