A practical approach to the management of pediatric fecal incontinence

We describe the rationale and key aspects for success of a bowel management program for the treatment of pediatric fecal incontinence. A retrospective review was done of the medical strategies used for the treatment of over a 1000 patients with fecal incontinent, combining the experience of the authors' previously published reports (Peña A, Guardino K, Tovilla JM, et al. J Pediatr Surg 1998; 33:133-137 and Bischoff A, Levitt MA, Bauer C, et al. J Pediatr Surg 2009; 44:1278-1284) and additional treated patients after those publications. Emphasis was placed on the review of the key factors needed to achieve success. Through the years, we have learned important lessons that resulted in our current strategy which allows us to obtain better results than earlier in our series. At present, the key aspects for success are (a) to distinguish between true fecal incontinence and pseudoincontinence; (b) to determine the characteristics of the colon (dilated or nondilated), ascertained by looking at the patient's contrast enema, and determine the treatment strategy from this; (c) to monitor the result of the enema (amount of stool left in the colon) with daily abdominal radiographs during a 1-week period; and (d) to thereby modify the type of enema daily, depending on the clinical result, and the abdominal radiograph. Following a systematic rationale in the classification of patients with fecal incontinence and applying selectively, individualized management, it is possible to achieve a 95% success rate in patients suffering from fecal incontinence.