Functional fecal soiling without constipation, organic cause or neuropsychiatric disorders?

Area of Science:

• Pediatric Gastroenterology
• Child Urology

Background:

• Fecal incontinence in children is often linked to constipation, structural defects, or neuropsychiatric issues.
• A distinct group of children present with fecal soiling without these common underlying causes.

Purpose of the Study:

• To identify and characterize a subgroup of children with fecal soiling without apparent organic, neurological, or psychiatric causes.
• To investigate the underlying mechanisms and treatment outcomes for this specific patient group.

Main Methods:

• Screened hospital records for children with fecal incontinence lacking typical causative factors.
• Compared anorectal manometry findings with age-matched controls with idiopathic constipation and soiling.
• Assessed rectal sensation and correlated findings with clinical presentation and treatment response.

Main Results:

• Identified 13 children (8 boys, 5 girls) with fecal soiling, with a median age of 7.9 years.
• Impaired rectal sensation (median volume 45 mL vs. normal <15 mL) was the sole identified abnormality.
• Anorectal manometry did not differentiate this group from those with constipation-related soiling.
• Conservative treatment improved fecal continence in 6 of 8 cases with adequate follow-up.

Conclusions:

• A subgroup of otherwise healthy children experience fecal soiling due to isolated impaired rectal sensation.
• This condition is distinct from constipation-related fecal incontinence.
• Prognosis is generally favorable with conservative management, including education and dietary adjustments.