Fecal Incontinence in Children: Evaluation and Management
Fecal Incontinence in Children: Evaluation and Management
Background Faecal incontinence (FI) in children is a significant gastrointestinal problem, with great personal and social impacts. It is characterised by recurrent loss of faecal matter into the underwear. Both functional and organic causes contribute to its aetiology with the former predominating.
Aim To review the epidemiology, pathophysiology, clinical evaluation and management of functional faecal incontinence in children.
Methods A PubMed search was conducted using search terms f(a)ecal incontinence, and encopresis. Articles on epidemiology, pathophysiology, clinical evaluation, investigation and management of functional FI in children were retrieved and assessed.
Results Community prevalence of this distressing problem ranges from 0.8% to 7.8% globally. Male: female ratio varies from 3:1 to 6:1. The diagnosis of FI is often based on established clinical criteria. The majority (82%) have constipation associated functional FI. Biopsychosocial factors play a crucial role in the pathogenesis. Limited physiological testing of anorectal function is recommended in the diagnostic procedures, particularly in children with atypical symptoms and possible organic disorders. Management of FI needs a multidisciplinary approach which includes establishment of an effective doctor-patient partnership, understanding the underlying mechanisms, pharmacotherapy and behavioural treatment. Approximately 15% of children with functional nonretentive faecal incontinence (FNRFI) had the same symptoms at the age of 18 years.
Conclusion Significant therapeutic advances have been made for retentive faecal incontinence, but treatment options for functional nonretentive faecal incontinence are limited. Limited long-term outcome data show that the majority outgrow faecal incontinence. A substantial proportion of children progress to adulthood with faecal incontinence.
Faecal incontinence (FI) is a paediatric gastroenterological problem with profound personal and family impacts. The affected children present with a history of voluntary and/or involuntary passage of stools into the underwear. The characteristic aroma of faeces in these children predisposes them to stigmatisation, rejection and bullying at school, which subsequently result in school avoidance and social withdrawal.
Faecal incontinence was originally described in children who were neurologically handicapped. Subsequently, it had been observed in a significant percentage of otherwise healthy children. Irrespective of the differences in underlying pathology (organic or functional), these children have significantly lower quality of life and most of the time suffer silently. Therefore, it is not surprising that they develop behavioural, emotional and upbringing problems, learning difficulties, depression and also frequently subjected to maltreatment. This review appraises the definitions, epidemiology, pathophysiology, diagnostic evaluation, therapeutic advances and clinical care of children with functional FI.
Abstract and Introduction
Abstract
Background Faecal incontinence (FI) in children is a significant gastrointestinal problem, with great personal and social impacts. It is characterised by recurrent loss of faecal matter into the underwear. Both functional and organic causes contribute to its aetiology with the former predominating.
Aim To review the epidemiology, pathophysiology, clinical evaluation and management of functional faecal incontinence in children.
Methods A PubMed search was conducted using search terms f(a)ecal incontinence, and encopresis. Articles on epidemiology, pathophysiology, clinical evaluation, investigation and management of functional FI in children were retrieved and assessed.
Results Community prevalence of this distressing problem ranges from 0.8% to 7.8% globally. Male: female ratio varies from 3:1 to 6:1. The diagnosis of FI is often based on established clinical criteria. The majority (82%) have constipation associated functional FI. Biopsychosocial factors play a crucial role in the pathogenesis. Limited physiological testing of anorectal function is recommended in the diagnostic procedures, particularly in children with atypical symptoms and possible organic disorders. Management of FI needs a multidisciplinary approach which includes establishment of an effective doctor-patient partnership, understanding the underlying mechanisms, pharmacotherapy and behavioural treatment. Approximately 15% of children with functional nonretentive faecal incontinence (FNRFI) had the same symptoms at the age of 18 years.
Conclusion Significant therapeutic advances have been made for retentive faecal incontinence, but treatment options for functional nonretentive faecal incontinence are limited. Limited long-term outcome data show that the majority outgrow faecal incontinence. A substantial proportion of children progress to adulthood with faecal incontinence.
Introduction
Faecal incontinence (FI) is a paediatric gastroenterological problem with profound personal and family impacts. The affected children present with a history of voluntary and/or involuntary passage of stools into the underwear. The characteristic aroma of faeces in these children predisposes them to stigmatisation, rejection and bullying at school, which subsequently result in school avoidance and social withdrawal.
Faecal incontinence was originally described in children who were neurologically handicapped. Subsequently, it had been observed in a significant percentage of otherwise healthy children. Irrespective of the differences in underlying pathology (organic or functional), these children have significantly lower quality of life and most of the time suffer silently. Therefore, it is not surprising that they develop behavioural, emotional and upbringing problems, learning difficulties, depression and also frequently subjected to maltreatment. This review appraises the definitions, epidemiology, pathophysiology, diagnostic evaluation, therapeutic advances and clinical care of children with functional FI.