Clinical approach to fecal soiling in children

Area of Science:

• Pediatric Gastroenterology
• Childhood Functional Disorders

Background:

• Fecal soiling is a common childhood issue with varied causes.
• Potential causes include stool toileting refusal, functional constipation (encopresis), and organic diseases.
• Initial evaluation involves ruling out anatomical, neurological, and inflammatory conditions.

Purpose of the Study:

• To outline the diagnostic approach to fecal soiling in children.
• To describe treatment strategies for different causes of fecal soiling.
• To emphasize the importance of a multidisciplinary approach for managing constipation and encopresis.

Main Methods:

• Diagnostic workup includes history, physical examination, and potentially anorectal manometry, barium enema, or rectal biopsy.
• Treatment for stool toileting refusal involves returning to diapers/pull-ups.
• Management of functional constipation and encopresis combines medical therapy, nutrition, behavioral interventions, and laxative compliance.

Main Results:

• Most children with organic fecal soiling experience persistent incontinence despite medical management.
• Antegrade enema administration is an option for severe, medically refractory cases.
• A combined treatment approach significantly improves constipation and encopresis in compliant patients.

Conclusions:

• Fecal soiling necessitates a thorough diagnostic process to identify the underlying cause.
• Effective management relies on tailored interventions, including behavioral strategies and long-term compliance.
• Cow's milk protein intolerance should be considered and managed with dietary elimination if identified.