Childhood incidence of fecal incontinence

Fecal incontinence can occur in children for a number of different reasons, including birth defects or disease. However, the most common cause of fecal incontinence among children is chronic constipation.

Children who are already toilet trained often become constipated because they avoid having bowel movements. When stool is retained, it leads to the buildup of dry, hard stool in the rectum. Liquid stool may then be involuntarily released around the hard, impacted stool (fecal impaction) still inside the rectum. When this occurs in children as the result of withholding stool, it is called encopresis.

Warning signs of encopresis include:

• Fecal stains on underwear
• Refusal to go to the bathroom
• Squatting, crossing legs or rocking (to hold back a bowel movement)
• Pain with bowel movements
• Hard, dry stool
• Unable to eat much, despite feelings of hunger

Children may withhold their stool for any number of reasons. These include psychological reasons (e.g., stress, embarrassment, fear of unfamiliar settings) and physical concerns (e.g., to avoid pain associated with passing hard, dry stool). They may also be unwilling to use public toilets or to stop playing in order to have a bowel movement.

Repeated delay or withholding of bowel movements can cause a child to lose the sense of urgency that triggers the need to defecate. This can lead to constipation and fecal incontinence.

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Treatment of fecal incontinence in children is similar to that for adults. The first step is to consult a physician who may identify the cause of the incontinence. Medication may be necessary to resolve the underlying constipation or fecal impaction. Bowel training and diet modification may also be necessary to prevent future episodes of constipation or fecal incontinence.

Carlo Di Lorenzo and Marc A. Benninga
Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands