Fecal Incontinence

Fecal Incontinence: Excerpt from The Diagnostic Approach to Symptoms and Signs in Pediatrics

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.

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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

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