Condition

Fecal and Urinary Incontinence Related to the Spine

What You Need to Know

Fecal and urinary incontinence is common in children with certain congenital spine-related diseases.

Key Points

Fecal and urinary incontinence is common in children with certain congenital spine-related diseases. These conditions can interfere with bowel and urologic function. Affected children have normal bowel and urologic structures.

Causes and Symptoms

Children with these conditions cannot control their bowels or urine due to:

Damage or poor development of nerves necessary for these functions
Neurological issues disrupting messages from the brain to the bowel

This disruption can lead to motility problems and an inability to sense the urge to use the bathroom.

Treatment and Care

Treatment may include:

Medication
Bowel training
Surgery

Children with spinal cord conditions should be monitored for incontinence symptoms regularly.

Understanding Fecal and Urinary Incontinence Related to the Spine

Fecal and urinary incontinence are common issues seen in children with certain congenital spine disorders such as spina bifida, spinal cord injury, or tethered spinal cord syndrome. These conditions can result in disruption of nerve signals between the bowel and brain, leading to motility problems and an inability to control bowel movements or urine.

Recognizing the Symptoms of Fecal and Urinary Incontinence Related to the Spine

Symptoms may vary depending on the severity of the condition. Common symptoms include:

Constipation
Encopresis, also known as soiling
Overflow incontinence (when urine comes out involuntarily)
Neurogenic bladder, a condition that leads to frequent urination, retention, urgency to reach the bathroom, and urinary accidents at night

Although these symptoms may be uncomfortable and embarrassing for children, it's essential to discuss them with a pediatric specialist. Early diagnosis and treatment can help prevent long-term complications.

Causes and Risk Factors for Pediatric Incontinence

Several factors can contribute to fecal and urinary incontinence related to the spine, including:

Spina bifida or other congenital spinal disorders
Absent sacrum
Spinal cord injury
Sacrococcygeal teratoma
Tethered spinal cord syndrome
Previous surgeries or procedures on the spine

Children with these conditions should be monitored for incontinence symptoms regularly to ensure prompt treatment and prevent long-term complications.

Spina Bifida

A condition that occurs when the neural tube (the structure that forms the spinal cord and backbone) does not close completely during an unborn baby’s development. This results in spinal cord and nerve damage that can cause disabilities.

Forms of spina bifida vary in intensity. Myelomeningocele, for instance, is a severe form characterized by a fluid-filled sac formed in the lining of the spinal cord that protrudes through the vertebrae to the outside of the body. Learn more about our Spina Bifida Program.

Absent Sacrum

Sacrococcygeal Teratoma

Diagnosis of Fecal and Urinary Incontinence Related to the Spine

A thorough medical history and physical examination will typically be performed first to evaluate any underlying conditions or injuries that may be contributing to the incontinence. Additional tests, such as X-rays or MRI scans, may also be ordered to assess the spine and surrounding structures.

We offer the latest advanced diagnostic tests and tools to evaluate children who experience encopresis (soiling) as a result of spina bifida, myelomeningocele or other spinal disorders. These disorders are often diagnosed in the fetus.

These diagnostic tests include:

Abdominal ultrasounds to examine the kidneys, bladder and pelvic organs
Spinal ultrasounds to evaluate for spine abnormalities or other neurological problems
X-rays to examine the spine and sacrum

In addition to these tests, specialized motility studies, such as anorectal manometry and colonic transit time studies, may be conducted to evaluate the function of the bowel. These tests can help identify any issues with nerve communication between the brain and bowels.

Early Diagnosis Support

Learn how our Prenatal Pediatrics Institute can provide an early diagnosis for faster treatment.

Explore our Prenatal Pediatrics Institute

Treating Fecal and Urinary Incontinence Related to the Spine in Children

Non-Surgical Treatments

Medical treatments and surgery can often help restore some function of the bowel, but gaining full bowel control may not happen so quickly. For these children, fecal and urinary incontinence can cause anxiety, distress, embarrassment, and social problems. However, there are effective treatments for fecal and urinary incontinence for children with spine disorders. Our pediatric colorectal and urologic specialists collaborate to create individualized and effective treatment plans to ensure your child gains optimal bowel and urinary control and function. Through a comprehensive treatment plan, children can avoid or greatly decrease incidents of soiling and urinary accidents to achieve a better quality of life.

If your child has bowel incontinence due to spina bifida, myelomeningocele, or another congenital birth defect that affects the spine, their treatment plan will likely consist of a combination of different approaches. This may include changes in diet, lifestyle, medications, surgery and participating in a bowel management program.

Our Bowel Management Program implements a customized set of treatments to help your child stay clean and free from accidents. Your child benefits from working with nutritionists who create optimal diet plans and offer helpful tips for increasing fiber intake for parents of picky eaters. A nurse practitioner and child psychologist oversee treatment plans and adjust as needed.

Other non-surgical treatments include:

Enemas and bowel irrigation treatments to loosen stool and flush out waste
Medications such as laxatives
A healthy fiber-rich diet

Surgical Treatments

Malone Appendicostomy

Illustration of an appendicostomy A Malone appendicostomy (MACE) is a procedure where your surgeon constructs a valve or pathway from the belly button to the colon by connecting the appendix to the abdomen. The procedure does not entail the use of any artificial implants or devices because the valve is created using your child’s own tissue. A catheter is placed in the valve where a special solution is administered to flush the colon of stool. Following MACE, your child will spend about two days in the hospital and require follow-up visits with your surgeon at one month to ensure they are healing properly.

Illustration of a child on a toilet with an enema connection in his abdomen

Sometimes the appendix can be split and used for both the Malone and the Mitrofanoff appendicostomies (similar idea for access to the bladder), and on occasion the segment of the colon to be removed can be added to the bladder to make it larger (bladder augmentation).

Colon Resection

A colon resection may be performed to remove areas of the colon that are diseased, which may include areas of the large intestine, small intestine or rectum. This is only necessary in very rare cases unresponsive to medical treatments. The type of colon resection needed will depend on your child’s specific spinal disorder and the severity of their condition. Your child will typically spend one week in the hospital following a colon resection and require a one-month follow-up to ensure they have healed properly and to check for any complications.

Recovery and At-Home Care

If your child has had a Malone appendicostomy, their catheter will remain in place for approximately one month. It is very important to keep the valve open, as the body will naturally try to heal over the opening. Once the catheter is removed, a type of plug called an ACE stopper will be put in its place for about six months to prevent the opening from closing. Once a day, the plug will be removed to flush the colon.

Your care team will give you detailed instructions on how to care for your child’s Malone once you are home. You will need to flush enema fluid through the catheter once daily when your child returns to eating normally. It is common for the site to have drainage that is clear or light yellow. It is important to keep the Malone tube secured to your child’s abdomen (with clear tape dressing) but do not completely cover the opening. When bathing, clean around the tube insertion with soap and water and then pat dry. You may carefully clean around the area with a Q-tip.

You should call your child’s provider if you notice the following:

Abdominal swelling during or after flushing the colon
Fever
If the area or stitches holding the catheter in place becomes red and irritated
The tube falls out prior to your child’s follow-up visit

How to Care for Your Child's Malone Site After Surgery

This video reviews every day care measures for your child's MiniAce device. The goal of this video is to educate you on how to keep the Malone site clean and keep your child from getting an infection. Before performing any of the instructed steps in the video, always check with our team or your child's pediatrician for safety.

Explore more colorectal care videos

Play How to Care for Your Child's Malone Site After Surgery video

How to Perform a Rectal Enema on Your Child

Learn the right way to administer an enema. An enema will clean your child’s colon of stool. We want this to be a good experience for you and your family.

Make an Appointment

If you suspect your child is experiencing fecal or urinary incontinence related to a spinal disorder, it's essential to seek medical help. Our team can schedule your child’s appointment and provide compassionate, expert care.

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Meet Our Team

Our providers are specifically trained to care for the needs of children with fecal or urinary incontinence related to a spinal disorder, providing expert care when your child needs it most. Get to know our team.

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Departments that Treat Fecal and Urinary Incontinence Related to the Spine

Pediatric Colorectal & Pelvic Reconstruction

The Division of Pediatric Colorectal & Pelvic Reconstruction offers the latest advancements in diagnosis and treatment for all types of pediatric colorectal disorders. Learn more about our division.

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