Patient education: Fecal incontinence in children (The Basics)

What is fecal incontinence? — Fecal incontinence in children is when a toilet-trained child has bowel movements in places other than the toilet. It happens when a child loses control of their bowels. For example, a child might leak a bowel movement into their underwear or have a bowel movement while asleep.

Other terms for fecal incontinence are "encopresis" or "soiling."

What causes fecal incontinence in children? — Constipation is the most common cause of fecal incontinence in children. Constipation can make bowel movements hurt. Constipation can also cause bowel movements to be hard or small, or happen less often than normal. (Most children normally have about 1 soft bowel movement a day.) Sometimes, a child with constipation might try to avoid having bowel movements. This can make the constipation worse.

When a child is constipated, bowel movements (also called "stool") can build up inside the body. As a result, the nerves and muscles that control the release of bowel movements stop working as well as they should. This causes some of the bowel movement to leak out (figure 1).

Other causes of fecal incontinence can include:

●Problems with toilet training

●Emotional stress or changes in a child's schedule

●Some medical conditions

Should my child see a doctor or nurse? — If your child often leaks bowel movements in their underwear or has bowel movements in places other than the toilet, talk to your doctor or nurse.

Will my child need tests? — Maybe. The doctor or nurse will do an exam and talk with you and your child. Most children don't need tests. But if your child does, possible tests can include:

●An X-ray of the belly – This can show if bowel movements have built up inside the body.

●Blood tests – These can check for a medical condition that could cause fecal incontinence.

●Urine tests – Some children with fecal incontinence also have daytime wetting or wet the bed at night. A possible cause of this is a urinary tract infection (figure 2). Doctors might test a sample of your child's urine to look for infections.

How is fecal incontinence in children treated? — It depends on the cause. For fecal incontinence from constipation, doctors can:

●Give medicines to get rid of bowel movements that have built up – This treatment is sometimes called a "clean out."

●Give medicines to help your child have normal bowel movements – These medicines are called "laxatives." They make bowel movements easier to get out.

●Show you how to help your child develop good bowel habits. Here are some things you can do:

•Have your child sit on the toilet for a few minutes after each meal

•Give your child rewards for sitting on the toilet, whether they have a bowel movement or not

•Keep track of when your child has bowel movements – Write down when they try to use the toilet and when they have a bowel movement. This gives you and the doctor more information about any problems.

•Stay positive and calm, even if your child still has fecal incontinence sometimes – Avoid scolding your child. This can be stressful and make the problem worse.

If another medical condition is causing fecal incontinence, doctors can find it and treat it. If stress is the cause, good bowel habits can help. Sometimes, talking to a therapist can help with stress.

Ask your doctor if some simple diet changes could help your child. For example, it might help to:

●Give your child more fruit, vegetables, cereal, and other foods with fiber (table 1)

●Avoid milk, yogurt, cheese, and ice cream

●Make sure your child drinks plenty of water

But if your child has fecal incontinence, making diet changes alone probably won't fix the problem.

Can fecal incontinence in children be prevented? — If constipation or stressful situations are the cause, you can reduce your child's chances of getting fecal incontinence again. You can:

●Give your child the medicines the doctor prescribes, exactly as directed

●Make sure your child maintains good bowel habits

●Be patient. It can take several months or longer for children to get over fecal incontinence.

●Talk to the doctor or nurse about things that could be causing stress for your child. They might have ideas for how to help your child handle the stress.

If the doctor or nurse prescribes laxatives, don't stop giving them to your child without asking the doctor. Some parents worry that laxatives are not safe or will cause problems for their child in the future. But the fact is, laxatives prescribed for children are very safe. Stopping them too early could make fecal incontinence come back or get worse.

More on this topic

Patient education: Constipation in children (The Basics)
Patient education: Bedwetting in children (The Basics)

Patient education: Constipation in infants and children (Beyond the Basics)
Patient education: Toilet training (Beyond the Basics)