Colorectal Center

Expert Treatment for Fecal Incontinence

At the Colorectal Center, our team provides comprehensive care for children with fecal incontinence. Because fecal incontinence can be accompanied by other conditions, such as urinary incontinence, we work closely with other specialists throughout the medical center to ensure that our patients’ complex needs are met.

Treatment Options

For many patients, treatment involves following a balanced diet that our registered dietitian develops for them based on their specific needs. Other treatment methods can include taking recommended medications and participating in our Bowel Management Program.

A small percentage of patients with fecal incontinence may need surgery to remove part of the colon, correct an anatomic abnormality or create an alternative way of delivering enemas (Malone appendicostomy). And some patients benefit from sacral nerve stimulation, a novel treatment that involves implanting a device that delivers mild electrical pulses to the pelvic nerves. The Colorectal Center is one of only a few pediatric institutions in the world that offers sacral nerve stimulation to help children with fecal incontinence achieve bowel control.

Management and Treatment

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.