Fecal Incontinence

A child with fecal incontinence is unable to hold feces (stool) in his or her rectum until they get to a toilet. Reasons for fecal incontinence range from a sudden case of diarrhea to damaged muscles or nerves within the rectum. The rectum is the last section of the intestine that controls bowel movements and signals when it is “time to go.”

Our pediatric gastroenterologists at CHOC specialize in working with children of all ages—from infants to young adults—to diagnose fecal incontinence and treat its cause. We use advanced diagnostics and personalized treatment plans that address each patient’s medical, emotional and physical needs both now and in the future.

If you have concerns about your child’s ability to “hold” or regulate their bowel movements or their fecal incontinence is interfering with their quality of life, it is time to schedule an appointment with one of our pediatric gastroenterologists. With one of the largest motility teams in the region, we are able to see and begin treating patients faster than many other institutions. Learn more about the CHOC Gastrointestinal Motility Program.

What are the symptoms of fecal incontinence?

Children with fecal incontinence may leak stool when they are not using the toilet, especially when they cough, sneeze or pass gas. They may also pass stool before reaching the toilet.

Who is at risk for fecal incontinence?

Children most at risk of fecal incontinence are those with:

How is fecal incontinence diagnosed?

Fecal incontinence can resemble other conditions. In order to diagnose the condition, the child’s gastroenterologist will consider the following:

  • The child’s overall health and medical history
  • A description of the child’s symptoms, including:
    – When they occur
    – Any diet or physical activity that seem to cause the child’s fecal incontinence
    – Related concerns, such as pain, constipation or illness
    – How severe the events are
  • A physical exam.

Our gastroenterologists will also consider the results of imaging tests that might include:

  • Anal manometry. Using a thin, flexible tube, your child’s gastroenterologist checks how well the muscles and nerves around the anus and rectum are working.
  • Magnetic resonance imaging. MRI imaging may help determine problems with the structure of the anus and rectum. Learn more about MRI at CHOC.
  • Anorectal ultrasonography. Sound waves make images of the structures in the anus and rectum.
  • Proctography. This is an X-ray that helps the physician find out how much stool the child can store in their rectum and how their body handles stool. Learn more about X-rays at CHOC.
  • Proctosigmoidoscopy. Using a flexible tube, the doctor will look inside the child’s rectum and lower intestine for evidence of scars and/or inflammation.
  • Anal electromyography. Looks for signs of nerve damage in the pelvic floor and rectum.

The doctor may also ask about the child’s emotions and quality of life to find out how the condition are affecting them emotionally and socially, as fecal incontinence can threaten a child’s self-confidence.

How is fecal incontinence treated?

The treatment recommended for fecal incontinence depends on its cause. Patients might need to try more than one, or a combination of treatments, to manage fecal incontinence. Possible treatments include:

  • Medication. The child’s doctor may prescribe medication to help control diarrhea or other illnesses or diseases that contribute to fecal incontinence.
  • Muscle training. The child’s doctor may recommend certain exercises that could help strengthen the child’s pelvic floor muscles.
  • Biofeedback. This is a clinical tool that can help children learn to control their bowel movements.
  • Electrical stimulation. Implants that cause small electronic pulses may be surgically placed near important nerves to help manage bowel movements.
  • Surgery. In some cases, surgery may improve bowel function or fix a structural problem.

What are the complications caused by fecal incontinence?

Complications are problems caused by a person’s condition. With fecal incontinence, complications may include:

  • Emotional and social distress. Fecal incontinence can be embarrassing, and some children, teens or young adults might want to avoid school and social situations. Some children may become depressed because of fecal incontinence.
  • Physical irritation. Frequent exposure to feces and wiping can irritate the skin around the anus.
  • Poor nutrition. Over time, severe fecal incontinence may mean that your child’s body isn’t getting enough nutrition from food. Your child’s doctor may recommend nutritional supplements.

If the child’s fecal incontinence is due to frequent, ongoing diarrhea and the child has signs of dehydration, it is important to contact a doctor immediately.

How can fecal incontinence be prevented?

Many causes of fecal incontinence can’t be prevented. However, as families go through the process of diagnosis to find its cause, you might learn ways to help prevent episodes of your child’s incontinence. For example, if diet is to blame, avoiding certain foods or beverages may help. So might a high fiber diet with plenty of fluids. Certain treatments, such as bowel training, may help the child develop a schedule for going to the bathroom throughout the day and prevent accidents.

How can I manage my child’s fecal incontinence?

Living with fecal incontinence may require taking certain steps so that your child can keep enjoying his or her life, such as:

  • Work with your child’s doctor. Some treatment approaches may take time to become effective. Follow instructions for any medications your doctor gives you. Ask your child’s medical team if you do not understand how to properly use supplies. Contact your child’s doctor if you don’t see any improvement.
  • Try therapy. If fecal incontinence is damaging your child’s relationships, school or social life, or their overall quality of life, talking to a psychologist may help. CHOC gastroenterologists can help arrange psychosocial support services.
  • Keep a food diary. Keeping track of the foods your child eats and the days or times when fecal incontinence strikes can help reveal what may be contributing to your child’s fecal incontinence. A CHOC dietitian can meet with you and your child to help determine foods and beverages that may help lessen your child’s incontinence.
  • Bowel training. One way to reduce the risk of fecal incontinence is to encourage your child to use the toilet regularly and attempt a bowel movement.
  • Pack a change of clothing. Carrying fresh clothes and shoes, cleansing cloths and a spare bag to store any soiled items can help a child feel more confident in going out and resuming normal activities.
  • Wear absorbent pads or diapers. While learning to manage fecal incontinence, some families may wish to consider buying incontinence products, such as pads or diapers that absorb leaks and odors.
  • Take “fecal deodorant” medication. Talk to your child’s doctor about medication that can reduce odors associated with fecal incontinence.
  • Learn to care for delicate skin. Use cleansing and barrier products to prevent skin irritation and pain from fecal incontinence.