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Symptoms » Diarrhea » Book Sections

Fecal Incontinence



  • Definedas fecal soiling beyond 4 yrs of age. Until this age, children arelearning normal bowel control and bowel habits.
  • Primary fecal incontinence exists whenchild has never achieved adequate bowel control; secondary fecalincontinence exists when child begins to soil after having achievedbowel control.

    • Principal Causes of Fecal Incontinence

    1. Maturationaldelay or developmental conflict
    2. Stress-related factors
    3. Constipation
    4. Neurologic disorders
      1. Mentalretardation
      2. Spinal dysraphism
      3. Spinal cord injury
      4. Spinal cord tumor
    5. Primary psychologic disturbance

    Clinical Features and Diagnosis

    Maturational Delay or Developmental Conflict

  • Some childrenexperience maturational delay in developing bowel control. Others havenever been toilet trained.
  • Sometimes developmental conflicts resultin fecal incontinence.
  • History and normal physical exam arediagnostic.

    • Stress-Related Factors

  • Stress iscommon cause of secondary fecal incontinence. Stress-related factorsinclude illness, separation, birth of sibling, attending new school,death of family member, parental divorce, or any other personalor family upset.
  • History and normal physical exam arediagnostic.

    • Constipation

  • Chronicconstipation from functional fecal retention is thought to be majorcause of encopresis, which is defined as fecal incontinence notresulting from illness or organic disorder.
  • Most cases of encopresis occur in school-agedchildren, who soil their underclothes.
  • See Chap.9, Constipation.

    • Neurologic Disorders

  • Childrenwith mild mental retardation may have delay in achieving bowel control, whilesome with severe retardation never achieve control.
  • Spinal dysraphism, spinal cord injury,or spinal cord tumor can be associated with fecal incontinence.

  • History andphysical exam, including rectal and neurologic exams, screen forthese disorders. Often there is history of lower extremity weakness,impaired sensation, and lack of bladder or bowel control. Strength,tone, sensation, and reflexes of lower extremities; back; anal sphinctertone; perianal sensation; and gait should be particularly examined.
  • Spine radiography, CT, and MRI locateand define extent of lesion.

    • Primary Psychologic Disturbance

  • Childrenwith severe behavioral disorders or psychosis may develop fecalincontinence.
  • History (including psychosocial historyof child and family), physical exam, clinical observation of child,and psychologic testing are diagnostic.

    • Diagnostic Approach

  • In childwith normal physical exam, most common causes of fecal incontinenceare maturational delay, developmental conflict, stress-related factors,and constipation. If primary psychologic disturbance exists, furtherevaluation should be performed by clinical psychologist or psychiatrist.
  • History and physical exam can screenfor a neurologic disorder. Relaxed anal sphincter tone, decreasedperianal sensation, lower extremity weakness, and urinary incontinencesuggest spinal cord lesion. Combination of spine radiography, CT,and MRI is usually diagnostic.

    • References

    1. Croffie JMB, Fitzgerald JF. Idiopathicconstipation. In: Walker WA, et al., eds. Pediatric gastrointestinaldisease, 3rd ed. Hamilton, Ontario, Canada: BC Decker, 2000:830–844.
    2. Rowe MI, et al. Essentials of pediatric surgery. St.Louis: Mosby-Year Book, 1995.
    3. Rudolph AM, ed. Rudolph's pediatrics, 20thed. Stamford, CT: Appleton & Lange, 1996.
    4. Tunnessen WW Jr. Signs and symptoms in pediatrics.3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999.

    Book Source Details

    • Book Title: The Diagnostic Approach to Symptoms and Signs in Pediatrics
    • Author(s): Paul S. Bellet
    • Year of Publication: 2006
    • Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2006 Lippincott Williams & Wilkins.

    Other Book Chapters Related to Diarrhea

    Read excerpts from these other book chapters related to Diarrhea:

    Medical Books Excerpts

    DIARRHEA, ACUTE

    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)

    DIARRHEA, CHRONIC

    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)

    Diarrhea - Acute

    • "In a Page: Signs and Symptoms" (2004)

    Diarrhea - Chronic

    • "In a Page: Signs and Symptoms" (2004)

    Diarrhea – Chronic, No Blood or Weight Loss

    • "In A Page: Pediatric Signs and Symptoms" (2007)

    Diarrhea – Chronic, with Weight Loss

    • "In A Page: Pediatric Signs and Symptoms" (2007)

    Diarrhea – Acute

    • "In A Page: Pediatric Signs and Symptoms" (2007)

    DIARRHEA

    • "Differential Diagnosis in Primary Care" (2007)

    Fecal incontinence

    • "Handbook of Signs & Symptoms (Third Edition)" (2006)

    Diarrhea

    • "Handbook of Signs & Symptoms (Third Edition)" (2006)

    Diarrhea

    • "A Pocket Manual of Differential Diagnosis" (1999)

    Fecal incontinence

    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)

    Diarrhea

    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)

    Diarrhea

    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)

    Acute Diarrhea

    • "Field Guide to Bedside Diagnosis" (2007)

    Chronic Diarrhea

    • "Field Guide to Bedside Diagnosis" (2007)

    Diarrhea

    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)

    Diarrhea

    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)

    Fecal Incontinence

    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)

    Diarrhea

    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)

    Fecal incontinence

    • "Nursing: Interpreting Signs and Symptoms" (2007)

    Diarrhea

    • "Nursing: Interpreting Signs and Symptoms" (2007)

    Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2008 Williams & Wilkins.

    More About Causes of Diarrhea



    More About This Book:
    Title: The Diagnostic Approach to Symptoms and Signs in Pediatrics
    Authors: Paul S. Bellet
    Publisher: Lippincott Williams & Wilkins
    Copyright: 2006
    ISBN: 0-78172-899-1

     » Next page: Diarrhea (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

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