Abstract
1. Marc A. Levitt, MD* 2. Alberto Pena, MD* 1. *Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. After completing this article, readers should be able to: 1. Describe the difference between true fecal incontinence and pseudoincontinence. 2. Understand the patient groups that suffer from true fecal incontinence. 3. Discuss the physiologic mechanisms of continence. 4. Formulate the evaluation and treatment of a patient who presents with soiling. 5. Develop a treatment protocol for constipation with overflow pseudoincontinence (encopresis). 6. Describe the primary differences between Hirschsprung disease and idiopathic constipation. Editor's Note: Fecal incontinence is a frustrating condition for patients, parents, and clinicians. This article discusses fecal incontinence caused by anatomic conditions as well as the overflow of stool that follows severe constipation. The perspective is that of the pediatric surgeon, and the discussion offers insights not always present in pediatric reviews. Some recommendations are derived from the extensive experience of the authors over many years of treating these patients. All figures for this article are contained in the data supplement Fecal soiling is a common problem that pediatricians are asked to evaluate. Fecal incontinence represents a devastating problem that may prevent a child from becoming socially accepted. More children are affected than previously believed, including those born with surgical conditions such as anorectal malformations (ARMs) and Hirschsprung disease (HD), as well as those who have spinal cord problems or injuries. Patients can have true fecal incontinence or can suffer from overflow pseudoincontinence. These two conditions have completely different treatments. Those who experience true incontinence include a percentage of surgical patients (who have ARMs and HD) as well as those who have congenital or acquired spinal problems. Pseudoincontinence (encopresis) occurs in patients who have the potential for bowel control but whose constipation leads to …
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