Fecal Incontinence

Fecal incontinence is the inability to control bowel movements, causing a child to repeatedly pass stool in inappropriate places. It is often related to constipation, though some children have fecal incontinence after surgery to correct an anorectal malformation or other condition in the rectal area.

Fecal incontinence that does not resolve with the usual therapeutic measures is called “intractable fecal incontinence.”

The symptoms of fecal incontinence depend on what type of the condition a child has.

An urge to have a bowel movement that comes on so quickly a child can't make it to the toilet in time is "urge fecal incontinence." A child who frequently soils their underwear with stool without realizing it has "passive fecal incontinence."

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

A number of tests can help determine the cause of fecal incontinence, including:

• Anorectal manometry measures nerve reflexes and the strength of the anal sphincter
• Abdominal X-ray can show a lack of stool or blockage in a child's large intestine or near the anus, as well as swollen segments of the large and small intestine
• Barium enema uses a chalky liquid called barium to coat the inside of organs and takes an X-ray so clinicians can look for abnormalities in the large intestine
• Colorectal transit study uses an X-ray to monitor the movement of markers through the intestine and colon
• Colonoscopy involves a long, flexible, lighted tube that is gently inserted through the rectum and into the colon so doctors can view the colon
• Colonic motility study measures the strength of the contractions of the large intestine

The objective of treatment is to enable the 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 the 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 a child learn to self-regulate the muscles and nerves in their bowels

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