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Fecal continence is one of the most important achievements
in a child’s development. Ability to control passage of stool is one of the
first manifestations of independence by which interaction with parents and
environment is exerted by the child.
Fecal continence, which is usually reached by the age of 2 or
3, may be partially or entirely compromised in children born with some
anomalies of the large bowel (anorectal anomalies and Hirschsprung’s disease)
or anomalies of the pelvic organs such as spina bifida.
Fecal incontinence has a significant social impact
regardless of the age it arises. Moral conditioning, which is usually
associated with toilet training, leads to a close association between stool and
something “dirty” and negative. It is not difficult to imagine the kinds of
difficulties a child can go through when he or she is unable to have bowel
control. Fecal incontinence represents a devastating problem; it is often a
barrier to social acceptance. It can affect many children including those with
prior surgery (for anorectal malformations and Hirschsprung’ s disease) as well
as those with spinal problems or injuries.
Nowadays, much can be done for children with fecal
incontinence. An accurate evaluation, along with an appropriate follow-up
program, can have an enormous impact on psychological and social consequences
of being incontinent.
Management and treatment involves distinguishing between true and pseudo incontinence, and then determining the proper protocol of treatment. Treatment of incontinence should be regarded as “care” aimed at raising a child in a normal context with a normal lifestyle. Pseudo incontinence (encopresis) can be treated with disimpaction followed by laxative therapy. True incontinence requires an enema program, with treatment tailored to either hypo or hypermotile colons. Bowel management is a treatment program which has been purposely conceived for children born with imperforate anus; however, it can be applied to all children with fecal incontinence.
Surgery for pseudo incontinence, which is rarely required, takes the form of colonic resection but only for patients with a demonstrated ability to have voluntary bowel movements, albeit with enormous laxative requirements. Removal of the rectosigmoid in this situation can reduce or eliminate the need for laxatives. Surgery for true fecal incontinence involves changing the route for a successfully demonstrated enema program to an antegrade, i.e., a Malone appendicostomy.
Get more information or request an appointment for the Colorectal Center. Contact us.
Listen to the archived livestream broadcast of Colorectal Center Director Marc Levitt, MD, answering questions on solutions for fecal incontinence related to spina bifida.
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