Fecal Incontinence

What is Fecal Incontinence?

Fecal incontinence is the inability to control bowel movements, causing accidental soiling. In toddlers who are still potty training, occasional accidents are normal. However, by about 4 years of age, when most children are toilet trained, children should be able to know when they need to use the bathroom.

If your child is struggling with this, you are not alone. Parents must understand that fecal incontinence is not intentional and not the child’s fault. Children with this condition often feel embarrassed or ashamed, and they need compassionate support and medical care rather than punishment.

Signs and Symptoms of Fecal Incontinence in Children

The main sign of fecal incontinence is that a potty-trained child is having recurring accidents. Some children experience urge incontinence, where they have a sudden, urgent need to have a bowel movement and can’t make it to the toilet in time. Other children may experience passive incontinence, where they may pass stool without realizing it.

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Causes and Treatments of Fecal Incontinence in Children

To have normal bowel function, three components in your body must work together:

Voluntary muscle control: Sphincter muscles regulate when stool is released
Sensation: The ability to feel when the rectum is full
Colonic motility: The movement of stool through the intestines

If any of these components are disrupted or don’t work properly, constipation or incontinence may occur.

Pseudoincontinence or Encopresis: This is a type of fecal incontinence in toilet-trained children that is often caused by chronic constipation or withholding stool. When kids regularly hold their bowel movements, it reduces the feeling of having to go, which then creates a self-perpetuating cycle: the longer stool is retained, the more likely the child is to soil.

Treatment focuses on preventing constipation through:

Dietary changes
Medications such as laxatives or stool softeners

True Fecal Incontinence: This can be an effect of another medical condition, such as constipation or congenital abnormalities that affect bowel control, including:

Spina bifida
Anorectal malformations
Hirschsprung’s Disease

This type of incontinence occurs in children who lack the nerve control or structures to regulate bowel movements.

Treatment for this type of fecal incontinence may involve:

Surgery
Bowel management programs
Daily enemas

When to See a Doctor

Schedule an appointment if your child:

Has frequent accidents despite toilet training
Complains of abdominal pain, bloating or painful bowel movements
Shows signs of chronic constipation (fewer than two bowel movements per week)
Has a history of congenital conditions affecting the intestines or spine

How is Fecal Incontinence in Children Diagnosed?

If your child is experiencing symptoms of fecal incontinence, the first step is to undergo an evaluation by your pediatrician. Your child’s doctor will evaluate their medical history, perform a physical exam, and may then order tests.

Extensive testing isn’t always required at the beginning. However, if your doctor wants to rule out an underlying condition or wants to rule out certain problems, they may recommend one or more tests.

Further testing may include:

Abdominal X-ray: to check for stool build-up. This can confirm severe constipation and help guide the first steps of treatment.
Barium enema: This is a special X-ray of the colon that helps identify abnormalities in the intestine’s shape or structural issues.
Anorectal manometry: This test uses a small soft tube or balloon that is placed briefly in the rectum to measure how the nerves and sphincter muscles are working. Manometry can be very useful if a nerve problem is suspected, or to evaluate children who aren’t improving with standard treatment.

Throughout the diagnostic process, the doctor’s goal is to identify the cause of the incontinence so they can tailor the treatment. They will also evaluate the child’s overall health and growth and whether issues like urinary incontinence or behavioral factors are present. It’s important for you to share any observations, such as the child’s toileting behaviors or stresses that occurred during the problem, because this information is very valuable in making the diagnosis.

Treatment for Fecal Incontinence in Children

The good news is that with proper treatment and support, most children can overcome fecal incontinence and develop good bowel control/ Treatment will depend on the cause, but the overall goal is always the same: to help your child have regular, predictable bowel movements in the toilet and avoid accidents. This improves your child’s comfort, health, and confidence. A treatment plan will usually involve a combination of medical, dietary, and behavioral strategies. Parents and your CHRISTUS care team will work together to find what works best for your child.

Treatment strategies may include:

Bowel management programs

A structured program to help your child regulate bowel movements and prevent accidents through:

Daily enemas: to clean the colon and prevent accidents
Dietary changes: including foods that loosen stool, and incorporating fiber-rich foods
Medications: Laxatives for constipation or medicines to slow bowel movements

Surgical Treatment for Fecal Incontinence in Children

For children who do not respond to diet and medication changes, surgery may be the best option to address underlying conditions or anatomical differences that cause the incontinence.

Talk to your child’s pediatric surgeon to see what option is best for your child.

Appendicostomy (Malone procedure): A small opening is created in the belly to make it easier to give enemas at home. It can help your child empty their bowels more comfortably and stay clean each day.
Cecostomy: A soft tube is placed in the first part of the large intestine. Through it, a gentle flush helps stool pass more easily, supporting your child’s daily routine and helping them feel more in control.

Tips for Supporting Your Child With Fecal Incontinence

Caring for a child with fecal incontinence requires empathy and encouragement. Here are some tips and points for parents and caregivers.

Establish consistent toilet habits by encouraging bathroom visits after meals. This can help train the body to go at convenient times. Make these bathroom visits low-stress: provide a footstool for comfort, read a short story, and never scold a child for an unsuccessful try. The idea is to give opportunities for bowels to empty regularly.

Ensure your child’s diet includes plenty of fluids and fiber-rich foods. High-fiber foods include berries, pears, prunes, vegetables, whole grain breads and cereals, oatmeal, and beans.

Use positive reinforcement, such as stickers or small prizes to encourage bowel training.

Plan ahead for school and extracurricular activities. Talk to your child’s teacher about the situation—just let them know your child has a medical issue that may require quick bathroom access. Ensure your child is free to use the restroom whenever they feel the urge, without having to wait for bathroom breaks. Your doctor can provide a letter to the school requesting restroom access. Keep a change of clothes available for school and other activities to help reduce embarrassment.

Remind your child that they aren’t alone. Many kids have this problem and get better. Help them practice ways to handle situations, such as raising their hand in class to use the restroom. If an accident happens, they can go see the nurse and change discreetly. As bowel control improvise, be sure to celebrate the child’s success and return focus to all the normal activities of childhood without fear of accidents.

Early intervention can significantly improve a child’s quality of life and help them gain confidence in managing their condition. If you’re worried about your child’s fecal incontinence or chronic constipation, reach out to your CHRISTUS Pediatrician. We will guide you step by step, answer your questions, and partner with you to ensure your child gets the effective care they need.

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