Pediatric fecal incontinence: A surgeon's perspective
Pediatrics in Review
• The goal for treatment of a child who has fecal incontinence is to have the child clean and wearing normal underwear, which is achieved either with medical treatment for patients who have the potential for bowel control or artificially with enemas for patients who have true fecal incontinence. • The program is an ongoing process of trial and error, is responsive to the individual patient, and differs for each child. The laxatives or the enema empty the colon, and if the colon remains quiet for the next 24 hours until the next treatment, the child stays clean. • Our routine is to employ either the laxative trial or the enema regimen during a 1-week outpatient program, with a daily abdominal radiograph checked as the regimen is tailored. Based on strong clinical evidence reviewing hundreds of children, more than 95% of children who follow this program become clean and dry. (7) • Clinicians should embrace the philosophy that no child who has fecal incontinence should go to school in diapers when classmates are already toilet trained. Successful anatomic reconstruction does not do much for a patient who continues to soil. Proper treatment to keep a patient clean and dry is perhaps more important than any surgical procedure itself.
Levitt, M., & Peña, A. (2010). Pediatric fecal incontinence: A surgeon's perspective. Pediatrics in Review, 31 (3). http://dx.doi.org/10.1542/pir.31-3-91