Review of organic causes of fecal incontinence in children: evaluation and treatment

Abstract

Even though fecal incontinence (FI) in children is most commonly the result of functional constipation, there are organic conditions that can be associated with incontinence. FI has a major impact on the quality of life of those children who experience it. The general objectives of any bowel program are to achieve predictability and independence. This is achieved by manipulating colonic transit and stool consistency and by producing more controlled evacuations, usually with the use of rectal interventions. Dietary interventions and medications can be used to change stool consistency or to manipulate transit by accelerating or slowing it down. Biofeedback or other interventions that increase sphincter pressure can also be used to improve anorectal function. Enemas or suppositories can be used to empty the sigmoid colon in a more controlled manner. With the recent advent of the antegrade colonic enemas, the patient can have predictable bowel movements and become independent.

Evaluation and Management of Postsurgical Patient With Hirschsprung Disease Neurogastroenterology & Motility Committee: Position Paper of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)

“…If the patient has a fecal impaction, they should undergo fecal disimpaction prior to initiation or escalation of medications. Osmotic laxatives, such as polyethylene glycol, lactulose, or milk of magnesia, should be used with caution when used for maintenance therapy as they make the stools looser and may worsen FI (63). As mentioned above, stimulant laxative, sennosides, and bisacodyl are the mainstay of maintenance treatment.…”

Three-dimensional High-resolution Anorectal Manometry in Children With Non-retentive Fecal Incontinence

“…Among them, the most common are congenital or acquired abnormalities such as anorectal malformations, anorectal trauma or disturbances in the nervous system. 6 To some extent, the actual mechanism of NRFI may not be recognized due to the lack of proper diagnostic methods. Threedimensional high-resolution anorectal manometry (3D-HRAM) is a new modality for the diagnosis of anorectal function.…”

Are all patients with short segment Hirschsprung’s disease equal? A retrospective multicenter study

“…Under this classification, patients with aganglionosis requiring the resection of a small length of the rectum or the entire recto-sigmoid colon would be grouped under the same category as short segment disease in most of the clinical studies on HSCR. However, it is well known that the sigmoid colon plays an important role in maintaining a normal bowel function and therefore the functional outcome should be different when it is resected or left in-situ [4].…”