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Fecal Incontinence

What is fecal incontinence (FI)?

Fecal incontinence is also called FI, incontinence, bowel incontinence, bowel control problems or fecal soiling. It happens when a child who has been toilet trained either voluntarily or involuntarily passes stool, or poops, in their underwear or in socially inappropriate places.

When/why does it happen?

Most children between 1 to 4 years old have 1 to 2 bowel movements a day, and more than 90% of these children poop every other day. But if a child becomes constipated and has problems pooping, they may begin to soil their clothing. Abnormal sensation, motility or muscular problems of the anorectal area can lead to chronic constipation and cause fecal incontinence. In some cases, it can be caused by a medical condition, such as Hirschsprung disease, anorectal malformations, cloaca, cloacal exstrophy, a spinal cord abnormality, or a metabolic disorder. That’s why it is important for a surgeon to evaluate your child.

What different types of FI are there?

Typically, we see FI in two different scenarios:

  • The first is when children have required surgery in the lower colon area. For example, children that have Anorectal Malformation (ARM), Hirschsprung disease or spinal conditions. These children have different bowel structures, even after surgery they may struggle with ability to control their poop.

  • The second type of child we see is one who has normal anatomy but has developed severe or chronic constipation. This is also referred to as encopresis. The child’s anatomy will allow them to have normal bowel movements, however they become so constipated and impacted that poop becomes impacted.

What symptoms occur?

Because constipation is most often the underlying reason for fecal incontinence, symptoms include 2 or fewer bowel movements per week, at least 1 episode of incontinence or stool leaking unexpectedly per week (if the child is toilet trained), a history of not pooping, painful or hard bowel movements, presence of a fecal mass in the rectum, and large diameter stools that stop up the toilet. Foul smelling gas, constipation and abdominal pain can also accompany FI.

How is FI diagnosed?

To diagnose fecal incontinence, your child’s doctor will perform a physical exam and will ask you a lot of questions about your child’s bowel habits, including how often your child poops, consistency of stools, size of stools, how old your child was when this began, and any other relevant medical or surgical history. If the doctor suspects an underlying problem, they may order other tests to diagnose the problem to be sure it is properly treated.

What related conditions may be present?

There are a number of other medical conditions that also can cause FI, including cerebral palsy, spina bifida, thyroid disorders and anorectal malformation, or imperforate anus. Hirschsprung disease is the most common cause of lower intestinal obstruction in infants. It is a condition where the end of a child's bowel does not contain all of the usual nerve cells. It occurs in approximately one in 5,000 newborns.

Is FI normal?

Parents typically want to know if fecal incontinence or fecal soiling is normal. The short answer is that it is not (especially after a child with typical anatomy has been toilet trained).

If your child is having frequent soiling accidents, it’s important to schedule an appointment with your child’s surgeon to determine next steps to address the problem. Your child may need a referral to a team of medical experts who specialize in diagnosing and treating FI, such as the Comprehensive Colorectal Center at Children’s Mercy.

Expert care at the Comprehensive Colorectal Center

Discussion of surgical and management options are best done with the help of a multidisciplinary team such as the one available at the Comprehensive Colorectal Center at Children’s Mercy.  

The Comprehensive Colorectal Center also specializes in caring for children with a history of:   

  • Anorectal malformation
  • Hirschsprung disease
  • Cloaca
  • Cloacal anomalies
  • Cloacal exstrophy
  • Sacral mass/ sacrococcygeal teratoma
  • Has had pelvic or colorectal trauma history  

How is FI treated?

Treatment will depend on the cause or type of fecal incontinence. If there is an underlying condition that causes differences in anatomy, we will discuss if diet and medications, enemas or surgery will work best to help regain control of bowel movements. A regular balanced diet that's high in fiber, fluids and/or a laxative regimen are all possible treatments for fecal incontinence and severe constipation. Another possibility is using enema therapy that will help to clean the colon daily.

What is the next step to treat FI?

First your doctor will discuss your child’s medical and surgical history. If surgery has taken place in the past, we may discuss how the surgery can affect pooping.

We will work with your family to find a way for your child to be clean for poop! If your child does not respond well to changes in diet and/or to a laxative (medical medicine) regimen, a medical grade rectal enema may be prescribed by your child’s health care team to help clean out the lower colon. During an enema, a soft flexible tube filled with saline water mixed with medicine is inserted into the lower part of the colon. Daily enemas can help keep your child’s colon clean and prevent soiling between enemas. An enema also can stop stool from getting stuck in the last part of the colon and can improve your child’s confidence in their ability to properly use the bathroom.


What are the surgical options to treat FI?

If your child needs an enema every day to prevent constipation or soiling accidents, the medical team may recommend a more comfortable way to give the enemas called an appendicostomy.


A cecostomy is a different procedure that may be recommended for your child, depending on their diagnosis and treatment plan. A cecostomy is a small plastic tube, Chait ™ or Mini ACE ™, that goes straight from the skin into the beginning part of the large intestine or colon. This creates a direct opening to the intestines, allowing them to be cleaned out daily, or flushed.

For both an appendicostomy and a cecostomy, liquid with medicines are given by placing a thin tube, or catheter, into the opening of the appendicostomy or into the cecostomy tube through a connection tube, or large syringe.