Pediatric Fecal Incontinence

Fecal incontinence means that you aren't able to hold your bowel movement (feces or stool) until you get to a toilet. There are many reasons for this. It might be a case of diarrhea that strikes suddenly. Or there could be damaged muscles or nerves in the rectum. The rectum is the last section of the intestine. It controls bowel movements, and signals when you need to go.

Fecal incontinence can be caused by a long-term (chronic) illness, injury, or surgery. Causes can include:

• Diarrhea or constipation
• Large hemorrhoids
• Injuries or diseases of the spinal cord
• Birth defects
• Diabetes
• Severe inflammation in the digestive tract
• Tumors
• Surgery that separates or widens the anal sphincters
• Rectal Prolapse

Symptoms of fecal incontinence include:

• Leaking stool when they aren't using the toilet. This might be when they cough or pass gas.
• Passing stool before they can reach the toilet

To diagnose your child's condition, your child's pediatrician will ask about your child's health history and will do a physical exam. The provider will also ask about their symptoms.

When you describe the symptoms, include:

• Any diet or physical activity that seems to cause your problem
• How severe the leaking stool is
• Related problems such as pain, constipation, or illness
• When the leaking occurs

Your child may need imaging tests, such as:

• Anal manometry. Your pediatrician uses a thin, flexible tube to check how well the muscles and nerves around the anus and rectum are working.
• MRI. MRI imaging may help find problems with the structure of the anus and rectum.
• Anorectal ultrasound. Sound waves make images of the structures in the anus and rectum.
• Proctography. This is an X-ray that helps your child's pediatrician find out how much stool they can store in their rectum and how their body handles stool.
• Proctosigmoidoscopy. Your pediatrician will use a flexible tube to look inside the rectum and lower intestine. He or she will look for scars, inflammation, or other conditions.
• Anal electromyography. This test looks for signs of nerve damage in the pelvic floor and rectum.

Your child's pediatrician may also ask about their emotional health and quality of life. This is done to find out how the condition is affecting them. Fecal incontinence can threaten self-confidence. And your child may worry about everything from odors to their appearance.

Complications are problems caused by your child's condition. With fecal incontinence, complications may include:

• Emotional and social distress. Fecal incontinence is embarrassing. Some people become depressed because of this problem.
• Physical irritation. Frequent exposure to feces and wiping can irritate the skin around your anus.
• Poor nutrition. Over time, severe fecal incontinence may mean that their body isn’t getting enough nutrition from their food. Your child's pediatrician may advise nutritional supplements.

You may need to take certain steps so that your child can keep enjoying their life. These steps include:

• Work with your child's pediatrician. Some treatment approaches may take time to work. Follow instructions for any medicines your child's pediatrician gives you. Ask your child's healthcare team if you don’t understand how to use supplies. Contact your child's pediatrician if you don’t see any improvement.
• Try therapy.  If fecal incontinence is damaging your child's overall quality of life, talking with a psychologist or therapist may help.
• Keep a food diary. Keep track of the foods your child eats and the days or times when fecal incontinence strikes. This could help show a pattern in their diet that contributes to their problem.
• Train your bowels. One way to reduce your child's risk is to use the toilet regularly and try to have a bowel movement.
• Pack a change of clothing. Always be prepared. Carry fresh clothes and shoes, cleansing cloths, and a spare bag to store any dirty items.
• Wear absorbent pads. While you’re learning to manage this condition, buy some incontinence products. These might be pads that absorb leaks and odors.
• Take “fecal deodorant” medicine. Talk with your child's pediatrician about medicine that can reduce odors linked to fecal incontinence.
• Learn to care for delicate skin.  Use cleansing and barrier products to prevent skin irritation and pain from this condition. Zinc oxide paste is one example of a barrier product.