Faecal Incontinence
Faecal Incontinence

This content created by Halil Tuğtepe, Prof. Dr. with attribution to scientific articles.

Faecal Incontinence

What Is Faecal Incontinence?

Faecal Incontinence, Encopresis or poop incontinence, is the unintentional leakage of stool. Typically, poo incontinence occurs when stool collects in the bowel or rectum (the endpoint of the bowel).

Anatomically and physiologically, the rectum which is the endpoint of the bowel is not a place where poop can be stored. It is used as a passage only at the extraction moment of poop from the body. If the rectum is filled with poop, it will become unable to hold after a while, and the soft poop leaks around the solid poop and causes the underwear to become dirty.

All children with toilet trained may experience poop accidents sometimes. This situation is normal especially at the ages of 2-4. Poop incontinence usually occurs after the age of 4 when a child learns to use the toilet. In most cases, dirt in the form of spread in underwear is a symptom of chronic constipation. Although it is rare, it can sometimes occur with the presence of emotional problems.

Poo incontinence is a difficult situation for parents and children. However, it is a health problem that rehabilitated with patience and correct treatment.

Reasons for Faecal Incontinence

Constipation is the principal cause of poop incontinence.

Poop incontinence due to postponement and Constipation: Most of the complaints of poo incontinence occur due to chronic constipation. The hard and dry poop in constipation can cause pain in the child during defecation. In these cases, children begin to hold their stools to avoid pain and form a vicious cycle between constipation and pain.

The children behaviours of avoidance of defecation result in poo incontinence after a while. The rectum cannot store that much poop and the muscles responsible for breech movements cannot hold the poop for that long.

Constipation, and poo incontinence with loss of sensation: If stool remains longer in the bowel, it becomes harder to extract from the body. Because in case of constipation, the pushing movement (peristaltic movement) of the bowel reduced gradually.

Besides, the accumulated large poop sticks to the inner surface of the bowel and blocks the poop sensation of the bowel. In this case, the child does not feel the new soft poop and the new poop leaks through the old poop. These poo accidents can be in the form of staining on underwear or in the form of large poo.

Conditions that trigger constipation given below;

  • Avoiding the use of outdoor toilets.
  • Postponement of poop due to not leaving the activity.
  • Not eating fibre foods
  • Not getting enough fluid intake.
  • Lactose intolerance (difficulty digesting milk and dairy products).

Stress and emotional situations: In addition to constipation, stressful situations, although rare, cause behavioural disorders in children and cause complaints of poo incontinence. Some situations that can cause stress in children are as follows;

  • Difficult toilet training.
  • Starting toilet training at a young age.
  • Breaking routines.
  • Starting school.
  • Parental divorce.
  • New sibling in the family.

Diarrhoea: Children may have diarrhoea due to being sick. In this case, they have trouble controlling their bowel movements. When diarrhoea disappears, also incontinence disappears at the same time.

Neurogenic or spinal cord diseases: Some neurological diseases that cause nerve damage make bladder and bowel movements difficult to control or eliminate the control mechanism.

Which Children Are In The Risk Group?

In terms of genetic predisposition, it is more likely to be seen in boys.

  • With chronic constipation.
  • Taking medications that can cause constipation, such as cough syrup.
  • Attention-deficit / hyperactivity disorder (ADHD)
  • Autism spectrum disorder
  • Spina bifida
  • Children who had anal atresia surgery.
  • It is more likely to occur in children with a predisposition to anxiety or depression.

What Are The Symptoms?

  • Leakage of stool or liquid stool on underwear, which may be mistaken for diarrhoea.
  • Dry, solid poo and constipation.
  • Poo, that blocks or nearly blocks the toilet.
  • Anorexia.
  • Abdominal pain.
  • Problems with daytime incontinence and/or bed-wetting.
  • Repeated bladder infections.

How Is It Diagnosed?

It may differ in each child. Some clinical examinations required to determine the cause of poo leakage.

The detailed history taking: With the history taking, the cause of poop leakage should be examined. Many families confuse diarrhoea with the staining on their children's underwear. However, this staining is a symptom of constipation, and if not treated, it can affect the bladder and cause urinary incontinence. For this reason, questioning the toilet and eating habits is very valuable for the treatment plan.

Physical evaluation: Since poo incontinence is mostly a sign of constipation, an abdominal examination should be performed. During the examination, the severity of constipation can be interpreted by looking at the intestinal motility and stiffness.

Also, the functions of the pelvic floor muscles (muscles around the anus) should be examined and their effectiveness in defecation should be evaluated. It is seen that the pelvic floor muscles of children with poop leakage are strain than normal. This is also a symptom of constipation.

EMG pelvic floor muscle measurement test: EMG measurements are made with electrodes to measure the tension and functionality of the pelvic floor muscles. Pelvic floor muscles of children with poo incontinence work excessively and lose the relaxation feature required for defecation. Before starting pelvic floor rehabilitation, the functions of the muscles should be evaluated so that they can work properly.

As the Tuğtepe Pediatric Urology team, we routinely perform the EMG pelvic floor muscle measurement test for our patients who apply to our clinic.

More comprehensive tests are usually ordered for severe poo incontinence complaints. The diagnostic tests requested when deemed necessary are as follows;

Tests requested for diagnosis:

  • Ultrasound: Increase in rectum diameter is an important criterion for diagnosis.
  • Abdominal X-ray: It is done to observe the fullness of the bowels.

How Is It Treated?

It is very important to start the treatment of poo incontinence as soon as possible to shorten the healing process. In the first stage, it should be started by removing the poop accumulated in the bowel from the body. Then the treatment plan should focus on healthy bowel movements.

Pelvic floor muscle rehabilitation: A group of muscles and soft tissues that make up the pelvic floor, supports the pelvic organs (bladder, intestine, and reproductive organ), helping to control bowel function. For example, when there is a feeling of defecation, the muscles around the anus strains, so allows him to arrive at the toilet, and during defecation, it relaxes and helps the stool to leave the body.

In some cases, constipation and poo leakage may occur because the pelvic floor muscles do not function correctly -cannot relax sufficiently. The fact that these muscles are very tense prevents them from healthily performing their functions. Therefore, re-training the muscles to regain their lost functions is very valuable for long-term permanent treatment.

Changing life habits: Constipation and incontinence can be reduced by simple changes in diet and toilet habits until the doctor's appointment.

Some suggestions for changes are as follows;

  • Avoiding constipation.
  • Consuming fruits and vegetables that are high in fibre.
  • Sufficient water consumption.
  • Restricting milk and dairy products.
  • Postponing early toilet training for young children.
  • Establishing toilet routines.

Changing living habits is difficult for children as well as for every individual. Therefore, you should be very gentle, avoiding sharp changes. During this period, the needs and expectations of the child should be listened. In some cases, the healing process may be prolonged according to the child's character. For this reason, parents should be very understanding and motivate their children to treatment in this process.

During the treatment process, children should be encouraged to adhere to the program without being blamed, criticized or punished. The biggest needs of children in this period will be love and support.

How Does Tuğtepe Pediatric Urology Team Treat?

As with other diseases, our approach to poo incontinence is multidisciplinary. By questioning the life habits of the patient who applied to our clinic, we ensure that they gain the most appropriate diet habits for their age. In our sessions, we teach the correct defecation techniques by giving detailed bladder-bowel training.

Children with constipation and poo incontinence put extra load on the pelvic floor muscles, so the muscles are disrupted. There will be a temporary recovery with only medication. However, the disease is likely to recur after a while. For this, the function of the muscles should be corrected with pelvic floor rehabilitation.

Relaxing the abdominal muscles, which play an important role in excretion, with manual therapy and breathing techniques, and re-rehabilitating the pelvic floor muscles enable us to offer successful treatments in the long term.

It shouldn't be forgotten that; With the treatment to be performed by experts, many health problems will be prevented.

What Happens When Not Treated or Treatment is Delayed?

Poo incontinence is often a symptom of chronic constipation. Therefore, the situation which affects the child's bowels health should be treated as soon as possible. More complex bladder-bowel problems arise when treatment delayed or neglected.

The constantly filled bowel disturbs the anatomically close bladder by squeezing it. After a while, impairment seen in the urination function of the bladder.

Many children with urinary incontinence during the day and/or night start with constipation. However, families do not care about the situation as much as urinary incontinence and prefer to delay the treatment. Constipation is a health problem that is easy to solve if treated, and its treatment shouldn't be delayed.

In addition to these, children whose treatment is delayed are left alone during the treatment process, so emotional problems are developed. Children with poo incontinence, avoid communicating and playing games with their peers by isolating themselves socially and psychologically. This situation can cause loss of self-confidence, communication problems and psychological problems.

Psychological problems are seen rarely among the causes of poo incontinence. However, untreated poo incontinence problem forms the basis of many psychological problems in the future.

When to See a Doctor?

You should consult your doctor to reveal the cause of poo incontinence. If your child has one or more of the following conditions, you have to consult your doctor.

  • Having trouble peeing, walking, or balance (this is an emergency).
  • Have constipation.
  • Have abdominal pain.
  • Leaks poop in places other than the toilet or potty.
  • If underwear gets dirty too often.
  • If over the age of three or four and still has poo leakage.
  • If urine leakage during the day and/or night.
  • If feels urgent urination during the day.
  • If urinates too often during the day.

 

Published: 03 Şubat 2021
Updated: 25 Şubat 2021

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