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Fecal incontinence in children
1Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242-1083, USA.
Insights
Most childhood fecal incontinence stems from functional constipation, not organic issues. Early diagnosis via history, physical exam, and tests like manometry guides effective treatment including diet and medication.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Functional constipation causes fecal incontinence in 95% of pediatric cases.
- Anatomical or neurological conditions account for the remaining 5% of pediatric fecal incontinence cases.
Purpose of the Study:
- To outline the diagnostic approach for pediatric fecal incontinence.
- To describe the management strategies for pediatric fecal incontinence.
Main Methods:
- Clinical history and physical examination (abdominal, rectal, neurological) are primary diagnostic tools.
- Anorectal manometry, barium enema, and rectal biopsy may be used to determine etiology in select cases.
- Treatment focuses on a structured plan including defecation trials, dietary fiber, and laxatives.
Main Results:
- Most children with fecal incontinence improve with conservative management.
- Surgical intervention is reserved for specific conditions like Hirschsprung's disease, anal stenosis, or post-surgical repair cases.
Conclusions:
- A systematic approach combining thorough evaluation and tailored treatment is crucial for managing pediatric fecal incontinence.
- Functional constipation is the predominant cause, necessitating a focus on conservative therapies.
Abstract:
Functional constipation is the cause of fecal incontinence in 95 percent of affected children, and anatomic or neurologic causes account for up to 5 percent of cases. The history and the physical examination (with emphasis on abdominal, rectal and neurologic examinations) are most helpful in identifying organic disease. In some children, anorectal manometry, a barium enema radiographic examination and a rectal biopsy are necessary to determine the etiology. Most children with fecal incontinence benefit from a strict treatment plan that includes defecation trials, a fiber-rich diet and laxative medications. Surgery followed by medical treatment is required in patients with Hirschsprung's disease and in some patients with anal stenosis or a history of surgical repair of an anorectal malformation.