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Functional Fecal Incontinence in Children: Epidemiology, Pathophysiology, Evaluation, and Management

Shaman Rajindrajith1, Niranga Manjuri Devanarayana2, Nikhil Thapar3

  • 1Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo 8.

Journal of Pediatric Gastroenterology and Nutrition
|February 3, 2021
PubMed

Insights

Functional fecal incontinence (FI) affects children globally, impacting their quality of life. Diagnosis often relies on clinical history and Rome IV criteria, with varied treatments for constipation-associated and nonretentive FI.

Area of Science:

  • Pediatric Gastroenterology
  • Child Psychology

Background:

  • Functional fecal incontinence (FI) is a common pediatric issue with significant psychological and quality-of-life impacts.
  • FI presents as either constipation-associated FI or nonretentive FI, regardless of the underlying pathophysiology.

Purpose of the Study:

  • To review the diagnosis and management of functional fecal incontinence in children.
  • To highlight the importance of Rome IV criteria and evolving diagnostic tools.

Main Methods:

  • Clinical history and physical examination using Rome IV criteria.
  • Review of evolving diagnostic investigations like high-resolution anorectal and colonic manometry.
  • Analysis of treatment strategies for different types of functional FI.

Main Results:

  • Rome IV criteria and clinical assessment are typically sufficient for diagnosing functional FI.
  • High-resolution manometry provides insights into the pathophysiology of functional FI.
  • Conventional treatments are effective for most constipation-associated FI, while nonretentive FI requires psychologically based approaches.

Conclusions:

  • Functional FI significantly affects children's well-being and requires tailored therapeutic options.
  • While constipation-associated FI often responds to standard interventions, nonretentive FI necessitates specialized psychological support.
  • Advanced interventions like botulinum toxin, transanal irrigation, and surgery may be considered for refractory cases.

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