Fecal Incontinence in Children
Hope Through Research
For More Information
Fecal incontinence is the inability to control your bowels.
When you feel the urge to have a bowel movement, you may not
be able to hold it until you can get to a toilet. Or stool
may leak from the rectum unexpectedly.
More than 6.5 million Americans have fecal incontinence.
It affects people of all ages--children as well as adults. Fecal incontinence
is more common in women than in men and more common in older adults than
in younger ones. It is not, however, a normal part of aging.
Loss of bowel control can be devastating. People who have
fecal incontinence may feel ashamed, embarrassed, or humiliated. Some
don't want to leave the house out of fear they might have an accident
in public. Most try to hide the problem as long as possible, so they withdraw
from friends and family. The social isolation is unfortunate but may be
reduced because treatment can improve bowel control and make incontinence
easier to manage.
Fecal incontinence can have several causes:
damage to the anal sphincter muscles
damage to the nerves of the anal sphincter muscles or the rectum
loss of storage capacity in the rectum
pelvic floor dysfunction
Fecal incontinence is most often caused by injury to one or both of the
ring-like muscles at the end of the rectum called the anal internal and/or
external sphincters. The sphincters keep stool inside. When damaged, the
muscles aren't strong enough to do their job, and stool can leak out.
In women, the damage often happens when giving birth. The risk of injury
is greatest if the doctor uses forceps to help deliver the baby or does
an episiotomy, which is a cut in the vaginal area to prevent it from tearing
during birth. Hemorrhoid surgery can damage the sphincters as well.
Fecal incontinence can also be caused by damage to the nerves that control
the anal sphincters or to the nerves that sense stool in the rectum. If
the nerves that control the sphincters are injured, the muscle doesn't
work properly and incontinence can occur. If the sensory nerves are damaged,
they don't sense that stool is in the rectum. You then won't feel the
need to use the bathroom until stool has leaked out. Nerve damage can
be caused by childbirth, a long-term habit of straining to pass stool,
stroke, and diseases that affect the nerves, such as diabetes and multiple
Loss of Storage Capacity
Normally, the rectum stretches to hold stool until you can get to a bathroom.
But rectal surgery, radiation treatment, and inflammatory bowel disease
can cause scarring that makes the walls of the rectum stiff and less elastic.
The rectum then can't stretch as much and can't hold stool, and fecal
incontinence results. Inflammatory bowel disease also can make rectal
walls very irritated and thereby unable to contain stool.
Diarrhea, or loose stool, is more difficult to control than solid stool
that is formed. Even people who don't have fecal incontinence can have
an accident when they have diarrhea.
Pelvic Floor Dysfunction
Abnormalities of the pelvic floor can lead to fecal incontinence. Examples
of some abnormalities are decreased perception of rectal sensation, decreased
anal canal pressures, decreased squeeze pressure of the anal canal, impaired
anal sensation, a dropping down of the rectum (rectal prolapse), protrusion
of the rectum through the vagina (rectocele), and/or generalized weakness
and sagging of the pelvic floor. Often the cause of pelvic floor dysfunction
is childbirth, and incontinence doesn't show up until the midforties or
The doctor will ask health-related questions and do a physical exam and
possibly other medical tests.
- Anal manometry checks the tightness of the anal sphincter
and its ability to respond to signals, as well as the sensitivity and
function of the rectum.
- Anorectal ultrasonography evaluates the structure of
the anal sphincters.
- Proctography, also known as defecography, shows how
much stool the rectum can hold, how well the rectum holds it, and how
well the rectum can evacuate the stool.
- Proctosigmoidoscopy allows doctors to look inside the
rectum for signs of disease or other problems that could cause fecal
incontinence, such as inflammation, tumors, or scar tissue.
- Anal electromyography tests for nerve damage, which
is often associated with obstetric injury.
Treatment depends on the cause and severity of fecal incontinence; it
may include dietary changes, medication, bowel training, or surgery. More
than one treatment may be necessary for successful control since continence
is a complicated chain of events.
Food affects the consistency of stool and how quickly it passes through
the digestive system. One way to help control fecal incontinence in some
persons is to eat foods that add bulk to stool, making it less watery
and easier to control. Also, avoid foods that contribute to the problem.
They include foods and drinks containing caffeine, like coffee, tea, and
chocolate, which relax the internal anal sphincter muscle. Another approach
is to eat foods low in fiber to decrease the work of the anal sphincters.
Fruit can act as a natural laxative and should be eaten sparingly.
You can adjust what and how you eat to help manage fecal
Keep a food diary. List what you eat, how much
you eat, and when you have an incontinent episode. After a few days, you
may begin to see a pattern between certain foods and incontinence. After
you identify foods that seem to cause problems, cut back on them and see
whether incontinence improves. Foods that typically cause diarrhea, and
so should probably be avoided, include
- cured or smoked meat like sausage, ham, or turkey spicy
- dairy products like milk, cheese, and ice cream
- fruits like apples, peaches, or pears
- fatty and greasy foods
- sweeteners, like sorbitol, xylitol, mannitol, and fructose,
which are found in diet drinks, sugarless gum and candy, chocolate,
and fruit juices
Eat smaller meals more frequently. In some people,
large meals cause bowel contractions that lead to diarrhea. You can still
eat the same amount of food in a day, but space it out by eating several
Eat and drink at different times. Liquid helps
move food through the digestive system. So if you want to slow things
down, drink something half an hour before or after meals, but not with
Eat more fiber. Fiber makes stool soft, formed,
and easier to control. Fiber is found in fruits, vegetables, and grains,
like those listed below. You'll need to eat
20 to 30 grams of fiber a day, but add it to your diet slowly so your
body can adjust. Too much fiber all at once can cause bloating, gas, or
even diarrhea. Also, too much insoluble, or undigestible, fiber can contribute
to diarrhea. So if you find that eating more fiber makes your diarrhea
worse, try cutting back to two servings each of fruits and vegetables
and removing skins and seeds from your food.
Eat foods that make stool bulkier. Foods that contain
soluble, or digestible, fiber slow the emptying of the bowels. Examples
are bananas, rice, tapioca, bread, potatoes, applesauce, cheese, smooth
peanut butter, yogurt, pasta, and oatmeal.
Get plenty to drink. You need to drink eight 8-ounce
glasses of liquid a day to help prevent dehydration and to keep stool
soft and formed. Water is a good choice, but avoid drinks with caffeine,
alcohol, milk, or carbonation if you find that they trigger diarrhea.
Over time, diarrhea can rob you of vitamins and minerals.
Ask your doctor if you need a vitamin supplement.
Examples of foods that have fiber include
|Breads, cereals, and beans fiber
|1/2 cup of black-eyed peas, cooked
|1/2 cup of kidney beans, cooked
|1/2 cup of lima beans, cooked
|Whole-grain cereal, cold
1/2 cup of All-Bran
|3/4 cup of Total
|3/4 cup of Post Bran Flakes
|Whole-grain cereal, hot
|1 packet of (oatmeal, Wheatena)
|1 slice of whole-wheat or multigrain bread
|1 medium apple
|1 medium peach
|1/2 cup of raspberries
|1 medium tangerine
|1 cup of acorn squash, raw
|1 medium stalk of broccoli, raw
|5 brussels sprouts, raw
|1 cup of cabbage, raw
|1 medium carrot, raw
|1 cup of cauliflower, raw
|1 cup of spinach, cooked
|1 cup of zucchini, raw
Source: USDA/ARS Nutrient Data Laboratory
If diarrhea is causing the incontinence, medication may help. Sometimes
doctors recommend using bulk laxatives to help people develop a more regular
bowel pattern. Or the doctor may prescribe antidiarrheal medicines such
as loperamide or diphenoxylate to slow down the bowel and help control
Bowel training helps some people relearn how to control their bowels.
In some cases, it involves strengthening muscles; in others, it means
training the bowels to empty at a specific time of day.
- Use biofeedback. Biofeedback is a way to strengthen
and coordinate the muscles and has helped some people. Special computer
equipment measures muscle contractions as you do exercises--called Kegel
exercises--to strengthen the rectum. These exercises work muscles
in the pelvic floor, including those involved in controlling stool.
Computer feedback about how the muscles are working shows whether you're
doing the exercises correctly and whether the muscles are getting stronger.
Whether biofeedback will work for you depends on the cause of your fecal
incontinence, how severe the muscle damage is, and your ability to do
- Develop a regular pattern of bowel movements. Some
people--particularly those whose fecal incontinence is caused by constipation--achieve
bowel control by training themselves to have bowel movements at specific
times during the day, such as after every meal. The key to this approach
is persistence--it may take a while to develop a regular pattern. Try
not to get frustrated or give up if it doesn't work right away.
Surgery may be an option for people whose fecal incontinence is caused
by injury to the pelvic floor, anal canal, or anal sphincter. Various
procedures can be done, from simple ones like repairing damaged areas,
to complex ones like attaching an artificial anal sphincter or replacing
anal muscle with muscle from the leg or forearm. People who have severe
fecal incontinence that doesn't respond to other treatments may decide
to have a colostomy, which involves removing a portion of the bowel. The
remaining part is then either attached to the anus if it still works properly,
or to a hole in the abdomen called a stoma, through which stool leaves
the body and is collected in a pouch.
|What To Do About Anal Discomfort
The skin around the anus is delicate and sensitive. Constipation
and diarrhea or contact between skin and stool can cause pain or
itching. Here's what you can do to relieve discomfort:
Wash the area with water, but not soap, after a bowel movement.
Soap can dry out the skin, making discomfort worse. If possible,
wash in the shower with lukewarm water or use a sitz bath. Or try
a no-rinse skin cleanser. Try not to use toilet paper to clean up--rubbing
with dry toilet paper will only irritate the skin more. Premoistened,
alcohol-free towelettes are a better choice.
Let the area air dry after washing. If you don't have time, gently
pat yourself dry with a lint-free cloth.
Use a moisture barrier cream, which is a protective cream to help
prevent skin irritation from direct contact with stool. However,
talk to your health care professional before you try anal ointments
and creams because some have ingredients that can be irritating.
Also, you should clean the area well first to avoid trapping bacteria
that could cause further problems. Your health care professional
can recommend an appropriate cream or ointment.
Try using nonmedicated talcum powder or corn starch to relieve
Wear cotton underwear and loose clothes that "breathe." Tight clothes
that block air can worsen anal problems. Change soiled underwear
as soon as possible.
If you use pads or diapers, make sure they have an absorbent wicking
layer on top. Products with a wicking layer protect the skin by
pulling stool and moisture away from the skin and into the pad.
Because fecal incontinence can cause distress in the form of embarrassment,
fear, and loneliness, taking steps to deal with it is important. Treatment
can help improve your life and help you feel better about yourself. If
you haven't been to a doctor yet, make an appointment. Also, consider
contacting the organizations listed at the end of this fact sheet. Such
groups can help you find information and support and, in some cases, referrals
to doctors who specialize in treating fecal incontinence.
Everyday Practical Tips
- Take a backpack or tote bag containing cleanup supplies
and a change of clothing with you everywhere.
- Locate public restrooms before you need them so you
know where to go.
- Use the toilet before heading out.
- If you think an episode is likely, wear disposable
undergarments or sanitary pads.
- If episodes are frequent, use oral fecal deodorants
to add to your comfort level.
Incontinence in Children
If your child has fecal incontinence, you need to see a doctor to determine
the cause and treatment. Fecal incontinence can occur in children because
of a birth defect or disease, but in most cases it's because of chronic
Potty-trained children often get constipated simply because
they refuse to go to the bathroom. The problem might stem from embarrassment
over using a public toilet or unwillingness to stop playing and go to
the bathroom. But if the child continues to hold in stool, the feces will
accumulate and harden in the rectum. The child might have a stomachache
and not eat much, despite being hungry. And when he or she eventually
does pass the stool, it can be painful, which can lead to fear of having
a bowel movement.
A child who is constipated may soil his or her underpants.
Soiling happens when liquid stool from farther up in the bowel seeps past
the hard stool in the rectum and leaks out. Soiling is a sign of fecal
incontinence. Try to remember that your child did not do this on purpose.
He or she cannot control the liquid stool and may not even know it has
The first step in treating the problem is passing the
built-up stool. The doctor may prescribe one or more enemas or a drink
that helps clean out the bowel, like magnesium citrate, mineral oil, or
The next step is preventing future constipation. You will
play a big role in this part of your child's treatment. You may need to
teach your child bowel habits, which means training your child to have
regular bowel movements. Experts recommend that parents of children with
poor bowel habits encourage their child to sit on the toilet four times
each day (after meals and at bedtime) for 5 minutes. Give rewards for
bowel movements and remember that it is important not to punish your child
for incontinent episodes.
Some changes in eating habits may be necessary too. Your
child should eat more high-fiber foods to soften stool, avoid dairy products
if they cause constipation, and drink plenty of fluids every day, including
water and juices like prune, grape, or apricot, which help prevent constipation.
If necessary, the doctor may prescribe laxatives.
It may take several months to break the pattern of withholding
stool and constipation. And episodes may occur again in the future. The
key is to pay close attention to your child's bowel habits. Some warning
signs to watch for include
- pain with bowel movements
- hard stool
- refusal to go to the bathroom
- soiled underpants
- signs of holding back a bowel movement, like squatting,
crossing the legs, or rocking back and forth
Why Children Get Constipated
- They were potty-trained too early.
- They refuse to have a bowel movement (because of painful ones
in the past, embarrassment, stubbornness, or even a dislike of
- They are in an unfamiliar place.
- They are reacting to family stress like a new sibling or their
- They can't get to a bathroom when they need to go so they hold
it. As the rectum fills with stool, the child may lose the urge
to go and become constipated as the stool dries and hardens.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
conducts and supports research into many kinds of digestive disorders,
including fecal incontinence. In addition, researchers throughout the
country are working hard to find possible solutions to the problem of
fecal incontinence. Some studies address fecal incontinence due to anal
sphincter damage and combine surgical procedures with electrical stimulation.
You can get information about fecal incontinence, as well as support,
American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2672
Phone: (913) 906-6000
International Foundation for Functional Gastrointestinal
P.O. Box 17864
Milwaukee, WI 53217
Phone: 1-888-964-2001 or (414) 964-1799
Fax: (414) 964-7176
|This author does not endorse or favor any
specific commercial product or company. Trade, proprietary,
or company names appearing in this document are used only
because they are considered necessary in the context of
the information provided. If a product is not mentioned,
this does not mean or imply that the product is unsatisfactory.