Bowel management for the treatment of pediatric fecal incontinence

Abstract

Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a bowel management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process.

Fig. 1

Contrast enema showing a dilated rectosigmoid

Fig. 2

Contrast enema showing a non-dilated colon

Fig. 3

Destroyed anal canal after a Hirschsprung’s disease operation. a External appearance (patulous anus). b Anal examination shows colonic mucosa anastomosed to skin (no pectinate line)

Fig. 4

Redundant non-dilated colon of patients with spina bifida

Fig. 5

Contrast enema showing a spastic rectosigmoid, after prolonged use of a phosphate-based enema

Fig. 6

Child’s position to receive an enema according to their ages. Reprinted from Peña A, Levitt MA (2005) Pediatric surgical problems. In: Corman ML (ed) Colon and rectal surgery with kind permission from Lippincott Williams and Wilkins

Fig. 7

Enema technique showing the tube high in the left colon

Fig. 8

Enema technique showing the Foley balloon inflated. Reprinted with kind permission from Ref. [38]

Fig. 9

Abdominal radiograph showing stool in the rectum and descending colon

Fig. 10

Abdominal radiograph showing a completely clean colon