Intractable Fecal Incontinence

Fecal incontinence is the inability to control bowel movements, causing unexpected stool (feces) to leak. “Intractable” fecal incontinence is incontinence that is difficult to manage or treat. In many cases incontinence can occur in the presence of constipation, and in others it may be related to difficulties after surgical correction of anorectal problems (like anorectal malformations) or other surgeries.

If your child does not respond to typical therapies for incontinence, or if he has had surgery of the anal region, our team will determine where and what the problem is.

Boston Children’s GI motility team uses a holistic approach to treatment. We perform tests to understand how your child’s entire gastrointestinal system is working, including the nerves in the intestines that are often responsible for incontinence. This allows us to develop an effective treatment plan.

What Causes Fecal Incontinence in Children?

Common causes of fecal incontinence include:

  • Diarrhea
  • Constipation
  • Problems with muscles or nerves
  • Hirschsprung’s disease
  • Congenital malformations of the anorectal area, like imperforate anus
  • Neuropathic conditions, like spina bifida

Because fecal incontinence can be accompanied by other conditions, such as urinary incontinence or constipation, we work closely with other specialists throughout Boston Children’s to ensure that we meet your child’s complex needs.

Fecal Incontinence Tests at Boston Children’s

Our GI motility team offers a number of tests to help determine the cause of fecal incontinence in your child. They include:
  • Anorectal manometry: A test that measures nerve reflexes, how strong the anal sphincter is, and the ability to squeeze and to sense
  • Abdominal X-ray: This can show a lack of stool or blockage in your child’s large intestine or near the anus, as well swollen segments of the large and small intestine.
  • Barium enema: This procedure examines the large intestine for abnormalities. We place a fluid called barium into the rectum as an enema. Barium is a chalky liquid used to coat the inside of organs so that they will show up clearly on an X-ray.
  • Colorectal transit study: This procedure uses X-rays to monitor the movement of markers through the intestine and colon
  • Colonoscopy: We gently insert a long, flexible, lighted tube through the rectum and up into the colon in order to view the colon.
  • Colonic motility studies: Studies that measure the strength of the contractions of the large intestine

Read more about GI motility testing at Boston Children’s.

Advanced Treatments for Fecal Incontinence at Boston Children’s

Our objective is to enable your child to have bowel movements in a predictable and socially acceptable way. Treatment methods to achieve this include:

  • Dietary changes
  • Rectal interventions including specialized enemas
  • Cecostomy: A procedure that uses a tube placed in your child’s belly to flush stool out of the intestines.
  • Bowel and toilet scheduling
  • Counseling and psychotherapy
  • Biofeedback therapy: A type of sensory training that helps your child learn to self-regulate

Learn more about our GI motility treatments and approach at Boston Children’s.

Make an Appointment

For an appointment, more information or to obtain a second opinion for your child, please contact the Motility and Functional Gastrointestinal Disorders Center at 617-355-6055 or request an appointment online.