In Brief: Fecal Overflow Incontinence

Pathophysiology of Pediatric Fecal Incontinence. Di Lorenzo C, Benninga M. Gastroenterology. 2004;126 :S33– S40OpenUrlCrossRefPubMed

Encopresis and Soiling. Loening-Baucke V. Pediatr Clin North Am. 1996;43 :279– 298OpenUrlCrossRefPubMed

Encopresis. Loening-Baucke V. Curr Opin Pediatr. 2002;14 :570– 575OpenUrlCrossRefPubMed

Functional Fecal Retention with Encopresis in Childhood. Loening-Baucke V. J Pediatr Gastroenterol Nutr. 2004;38 :79– 84OpenUrlPubMed

Fecal overflow incontinence usually results from long-standing constipation that leads to encopresis or soiling. In a field in which the terminology has been far from consistent or clear, a clinically useful definition of constipation is a delay or difficulty in defecation for 2 or more weeks that is sufficient to cause significant distress to the patient. Encopresis is the frequent, inappropriate loss of a bowel movement, intentionally or unintentionally, in a child 4 years of age or older. Soiling is the leakage of small amounts of stool, resulting in stained underwear. “Encopresis” and “soiling” often are used interchangeably to denote fecal incontinence, with the difference between them being the quantity of stool passed.

Effectively treating fecal overflow incontinence begins with the understanding that constipation is the underlying problem. The constipation may be related to a primary disorder (organic constipation) such as Hirschsprung disease, pseudo-obstruction, anorectal malformation (including anterior displacement of the anus, anal stenosis, or imperforate anus), myelomeningocele, tethering of the spinal cord, and hypothyroidism as well as many other conditions. Most often by far, however, constipation is not caused by an underlying disorder (functional constipation). Although cases …