Pediatric Surgical Services Conditions & Treatments
With fecal incontinence, the normal mechanisms for bowel control either have been damaged or did not develop properly in the womb. Sever constipation, soiling of undergarments and bowel dysmotility can result from a wide range of unrelated physiological conditions, including:
- Functional (idiopathic) constipation – Large hard stools that cause watery stool to build-up and leak, soiling undergarments
- Fecal (idiopathic) incontinence – Unknown causes of fecal incontinence
- Imperforate anus – Present from birth, the opening to the anus is blocked or missing
- Anorectal malformations – Birth defects where the anus and rectum (the lower end of the digestive tract) do not develop properly
- Hirschsprung’s disease – Congenital disease that results in the blockage of the large intestine due to improper muscle movement in the bowel
- Spina bifida – A range of spinal deformities in which the bones of the spine do not fuse in the developing fetus
- Cloaca and cloacal extrophy – Both rare congenital conditions.
- Congenital recto-urethral fistula and recto-bladder neck fistula – A recto-urethral fistula results in both solid waste and urine emptying from the body through the urethra. A recto-bladder neck fistula is a connection between the rectum and the bladder causing urine and feces to mix and empty out of the urethra.
- Congenital recto-vestibular fistula and recto-vaginal fistula – A recto-vestibular fistula is characterized by a connection between the rectum and the vaginal vestibule. A congenital recto-vaginal fistula is characterized by the abnormal connection of the rectum to the vagina resulting in the passing gas or feces through the vagina as it leaks through the fistula.
Diagnosing Bowel Problems
The Pediatric Bowel Management Program may diagnose fecal incontinence based on a child's medical history, physical examination and one or more medical tests. Keeping a stool diary for several weeks before your appointment may help answer the physician’s questions about your child’s condition. The type and severity of your child's underlying condition will affect the recommended course of treatment.
Specific diagnostic test may be used to evaluate the sources of bowel problems, including:
- Anal manometry
- Flexible sigmoidoscopy or colonoscopy
- Intestinal contrast studies
- Magnetic Resonance Imaging (MRI)
Treatment options for fecal incontinence may include:
- Diet and Nutrition Changes
Often times, fecal incontinence can be controlled with dietary improvements. Fiber, found in fruits, vegetables and whole grains can reduce diarrhea and constipation. Supplements also may be a good source of fiber. Consuming water and controlling intake of caffeine, milk and carbonated fluids can avoid triggers for certain incontinence issues. Keep a food diary to track daily intake of foods and how they affect your child.
Certain antidiarrheal medications such as loperamide or diphenoxylate may be prescribed by physicians to slow down certain types of fecal incontinence.
- Bowel/Muscle Training
Training involves trying to have bowel movements at specific times of the day, such as after every meal. Over time, the body becomes used to regular bowel movement patterns, thus reducing constipation and related fecal incontinence. Children with fecal incontinence may need an enema to empty the colon each day and stay clean wearing regular undergarments during muscle training.
- Enemas and Laxatives
Depending on the underlying condition, some children benefit from daily enema therapy, which induces a complete emptying of the bowel.
If your child is a good candidate for enema therapy, our team will provide you with equipment and training to administer this treatment in the future. We will closely monitor your child’s progress and the treatment’s effectiveness to make adjustments as needed.
For many patients, effective daily enema therapy prevents accidental soiling and allows the child to transition back into regular undergarments. This type of therapy also addresses issues of chronic constipation.
Eventually, when your child is ready, the doctor may ask you to transition treatment from daily enemas to laxative therapy.
- Surgical Correction of Malformations
Some patients with complex anorectal or congenital malformations, including Hirschsprung’s disease, may not initially be candidates for non-surgical bowel management.
In some cases, or to increase the likelihood of success in the bowel management program, your physician may recommend laparoscopic or open procedures such as Posterior Sagittal Anorectoplasty (PSARP) to reposition the anus. Alternative procedures may include stricturoplasty or bowel diversion in selected patients. Following full recovery, these patients usually become good candidates for bowel management.
- Long-Term Bowel Management
Patients with underlying conditions that require daily enemas may benefit from laparoscopic Antegrade Continent Enema (ACE) procedures, including the Malone antegrade continence enema (MACE) and cecostomy. The goal of ACE procedures is to create a path through the appendix as a conduit to flush the colon from above, thus eliminating the need for rectal enemas.
In the procedure, a surgeon connects the appendix to the abdominal wall and creates a small, unobtrusive valve (often hidden in the belly button) between the appendix and the outside of the body. The appendix conduit or cecostomy button makes the administration of enemas easier and more effective especially for older children.