Review of organic causes of fecal incontinence in children: evaluation and treatment

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Date: Sept. 2013
Publisher: Expert Reviews Ltd.
Document Type: Report
Length: 9,902 words
Lexile Measure: 1370L

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Author(s): Lusine Ambartsumyan 1 , Samuel Nurko [*] 2



ACE procedure; fecal incontinence; imperforate anus; myelodysplasia

In children the most common reason for fecal incontinence (FI) is from overflow, mainly in otherwise healthy children with constipation. However, it can also occur from a variety of organic conditions, mostly from congenital malformations of the anorectum or the spine, or other problems that cause dysfunction of the anorectum, the anal sphincters or the spinal cord [1,2] .

FI is common in children of all ages with worldwide prevalence of 0.8-7.8% [3-5] and is mostly associated with stool retention. There is a negative correlation between age and prevalence of FI [4] . It is more common in younger children with prevalence of 4.1% in the age group of 5- to 6-year-olds and 1.6% in 11- to 12-year-olds [3] . FI is more prevalent in boys with male to female ratio ranging 3:1-6:1 [3,4,6] . It accounts for 3% of pediatric gastroenterology referrals to teaching hospitals [1] . However, only 37.7% of 5- to 6-year-olds and 27.4% of the 11- to 12-year-olds sought medical care for incontinence [3] . Factors associated with higher prevalence include obesity, stressful life events, psychosocial problems, low socioeconomic status and low educational level [3-5,7] .

FI negatively impacts the quality of life of children and their families. Children with incontinence are found to have higher rates of psychosocial problems compared with those who do not. Behavioral and emotional problems, learning difficulty, abuse and upbringing problems are more common with odds ratios reported between 1.71 and 4.32 [3] . Parents report increased behavioral and emotional problems such as separation anxiety, social fears, obsessions, compulsions, attention and activity problems and oppositional behaviors [8] . FI has a significant impact on social functioning and self-esteem with higher rates of bullying, low global self-worth and antisocial activities reported by children who soil [8] . Approximately 30-50% of children with FI were reported to fulfill Diagnostic and Statistical Manual of Mental Disorders IV criteria for psychiatric disorders [3] . Whether the behavioral problems are the culprit of abnormal defecation or vice versa remains to be elucidated [6,9] .


FI is defined as the voluntary or involuntary passage of stool in an inappropriate place in a child with developmental age of 4 years or older [1,10] . The Paris Consensus on Childhood Constipation Terminology group recommends the use of FI in place of encopresis and soiling [10] . Later, the Rome III criteria adopted the same recommendations [1] . FI is divided into functional and organic in etiology. The latter accounts for <5% of the cases of FI and includes conditions that affect the anorectum, anal sphincters, myenteric nerves or the spinal cord [11] . Functional FI is further subdivided into constipation-associated FI or 'overflow' incontinence and nonretentive FI (NRFI), where the history and physical examination do not indicate underlying constipation [10] . Approximately 95% of the children have functional FI of which 80% are constipation-associated FI and 20% are NRFI [6,12] .

The present review will not address the presence of overflow incontinence in children with constipation. We will focus only on organic...

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Gale Document Number: GALE|A343898798