Minimally invasive treatment of fecal incontinence and constipation in children

Abstract

The capacity for voluntary bowel movements and thus fecal incontinence may be limited in children born with anorectal anomalies and Hirschsprung's disease, as well as for many patients with spinal problems. Some of these patients have severe constipation which if not properly managed causes overflow pseudoincontinence and some have true fecal incontinence. For patients with anorectal malformations and those with idiopathic constipation with overflow pseudoincontinence, disimpaction, followed by an aggressive laxative regimen, often makes them continent, i.e. capable of having voluntary bowel movements. Surgical resection of a dilated rectosigmoid can dramatically reduce or eliminate these patients' daily laxative requirement, and improve their quality of life. For patients with true fecal incontinence, a bowel management program with a daily enema allows them to be kept artificially clean. For these patients, a surgical procedure whereby the daily enema is given antegrade is ideal, but it is the enema itself not its route which is the key to success. It is vital for the clinician to distinguish between these groups. Their initial presentations are quite similar, i.e. "fecal incontinence" or soiling but the treatments and surgical options differ dramatically. Much of what we have learned in the care of pediatric fecal incontinence can be extrapolated to adults.