Fecal incontinence is the inability to control stool. Fecal incontinence can be a devastating problem that can impact school, social life, and other family members. It can affect many children including those who have had prior surgery (anorectal malformations, Hirschsprung’s disease) and those with spinal abnormalities or injuries.
Fecal continence is an important milestone in a child’s development. This is the first manifestation of a child’s independence. Three components are necessary to achieve fecal continence:
- Sensation within the rectum to feel that stool or gas is present
- Good motility of the colon; peristaltic waves that move the stool through the rectum
- Good voluntary muscle or sphincter control, which allow for control and retention of stool
There are 2 types of fecal incontinence. It is important to distinguish between the two types in order to make a correct diagnosis and to determine a treatment plan that will help your child stay clean and accident free.
True Fecal Incontinence
In true fecal incontinence, the normal mechanisms for bowel control are damaged or did not develop normally. The muscles which cause peristalsis (movement of stool through colon) and the anal sphincter may not work. The nerves that sense stool in the rectum may not function properly. Children born with anorectal malformations (imperforate anus) or spinal cord problems (spina bifida) may have problems with these muscles and nerves.
This may look like true fecal incontinence, but these children have the ability for bowel control. In severe constipation the colon moves slowly, the stool gets hard and can cause a fecal impaction. Liquid stool then leaks around the hard stool and causes soiling. After treating the fecal impaction and managing the constipation, the child becomes continent.
Children with true fecal incontinence will need an artificial way (enema) to empty the colon each day to stay clean and in normal underwear. The Colorectal Center at Primary Children’s Hospital offers a bowel management program tailored specifically to your child to keep him clean every day. We have seen children get involved in social activities, improve in school, and have a better relationship with family members after our bowel management program.
If long-term enemas are needed, an appendicostomy (or Malone procedure, sometimes called a MACE or ACE) is an option once we have established an enema program that is effective in cleaning the colon daily and keeping your child free of accidents. With an appendicostomy, the daily enema will be given through an opening on your child’s belly, providing privacy and future independence for your child.