State of the art: pathophysiologyPathophysiology of pediatric fecal incontinence
Section snippets
Functional fecal retention with overflow soiling
Functional fecal retention, the most common chronic defecation disorder in children, is the withholding of feces because of fear of painful defecation. This condition is responsible for up to 25% of visits to pediatric gastroenterologists and 3% to 5% of visits to general pediatricians.2 Typically, it develops at the time of toilet training or when the child starts school. Functional fecal retention is most likely the result of long-standing stool retention in the rectum. The increasing
Functional nonretentive fecal soiling
A subset of patients (male to female ratio of 4:1) lacks a history of functional fecal retention and instead has voluntary or involuntary evacuation of fairly large bowel movements in their underwear. According to the Rome II criteria,8 children older than age 4 years who present with this symptom at least once a week are considered to have functional nonretentive fecal soiling (FNRFS). Children with FNRFS often have daily bowel movements in the toilet and have a nearly complete stool
Anorectal malformations
Anorectal anomalies are congenital defects that occur once in 3000 to 5000 live births and are more common in boys. They can range from minor defects that require simple surgery to complex lesions requiring a high degree of skill and technical expertise to correct. These anomalies may be attributed to defective development of the lower rectum, urogenital tract, and anus in utero.
Spinal problems
Spina bifida occurs in about 1 in 1000 live births, making it the most common birth defect after trisomy.19 Typically, it is characterized by paralysis and lack of sensation below the level of the lesion. Myelomeningocele, the most common type of open spina bifida, usually affects the lumbosacral region and is associated with bowel and bladder dysfunction. Urinary and bowel incontinence are common because the rectoanal inhibitory reflex is preserved but the urge for defecation may be lost. The
Miscellaneous causes
Hirschsprung disease (congenital aganglionosis) is the most common cause of lower intestinal obstruction in neonates. Theoretically, surgical removal of the aganglionic segment is a lifesaving procedure that can correct Hirschsprung disease and normalize defecation. However, defecatory problems are common even years after surgery: Up to 50% of children have constipation or fecal incontinence, regardless of the surgical technique used.27 The high prevalence of defecatory disturbances after
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2022, Seminars in Pediatric SurgeryThe use of biofeedback for children with fecal incontinence secondary to retentive constipation: Experience of a French Pediatric Center
2021, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :Fecal incontinence (FI) secondary to chronic retentive constipation is a frequent demand in pediatric gastroenterology clinics [1]. It is defined by involuntary loss of fecal matter due to overflow, following the withholding of feces in the rectum in children over the age of 4 years [2]. It affects quality of life and can lead to serious psychosocial health disorders [2].
Coexistent faecal incontinence and constipation: A cross-sectional study of 4027 adults undergoing specialist assessment
2020, EClinicalMedicineCitation Excerpt :However, this could equally reflect misconceptions about the relevance of such questioning in different patient populations. Most clinicians will be aware of the coexistence of such symptoms in paediatric and geriatric populations [6-12]. However in adults, such questioning may be guided by a notion of risk.
Quality of life in children with pseudoincontinence after implementing a bowel management program in Egypt
2020, Journal of Pediatric SurgeryBotulinum toxin injection for childhood constipation is safe and can be effective regardless of anal sphincter dynamics
2018, Journal of Pediatric Surgery