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Coexistence of constipation and incontinence in children and adults
1Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, United States. samuel.nurko@childrens.harvard.edu
Insights
Constipation and fecal incontinence often coexist in adults, though this is underrecognized. Treating constipation typically improves incontinence, highlighting the importance of addressing underlying bowel issues.
Area of Science:
- Gastroenterology
- Urology
- Pelvic Floor Health
Background:
- Constipation and fecal incontinence frequently coexist in pediatric and geriatric populations.
- This comorbidity is significantly underappreciated in the general adult population.
- Functional fecal incontinence in children is often linked to constipation, stool retention, and urinary incontinence.
Purpose of the Study:
- To review the epidemiology and pathophysiology of coexistent constipation and incontinence in children and adults.
- To examine the clinical presentation and treatment response in pediatric cases.
- To increase awareness of this common comorbidity in adults.
Main Methods:
- Literature review of existing studies on constipation and fecal incontinence.
- Analysis of pathophysiology, including overflow and pelvic floor dysfunction.
- Synthesis of data on pediatric and adult populations.
Main Results:
- Incontinence significantly impacts quality of life and daily functioning.
- In children, incontinence can be associated with behavioral issues.
- Pathophysiology involves overflow, and in adults, potentially pelvic floor dysfunction and denervation.
Conclusions:
- Treating underlying constipation is key to improving fecal incontinence.
- Further research is needed to fully understand adult pathophysiology.
- Increased recognition and management of this comorbidity are essential.
Abstract:
The coexistence of constipation and fecal incontinence has long been recognised in paediatric and geriatric populations, but is grossly underappreciated in the rest of the adult population. In children, functional fecal incontinence is usually associated with constipation, stool retention and incomplete evacuation, and is frequently allied to urinary incontinence. Pathophysiology of the incontinence is incompletely understood, although both in children and adults, it is thought to be secondary to overflow, while in adults it may also be related to pelvic floor dysfunction and denervation. Incontinence has an important impact on quality of life and daily functioning, and in children may be associated with behaviour problems. The treatment of underlying constipation usually results in improvement in incontinence. This review broadly addresses the epidemiology and pathophysiology of coexistent constipation and incontinence in both children and adults, and also reviews clinical presentation and treatment response in pediatrics.
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