TREATMENTS &
RESEARCH

Search the
latest
treatment
information
here.

Dr. Huntley's
Diagnosis
Checklist

Have a symptom?
See what questions
a doctor would ask.
 
Next Prev
Symptoms » Fecal straining » Book Sections
 

Fecal Incontinence

  • Definedas fecal soiling beyond 4 yrs of age. Until this age, children arelearning normal bowel control and bowel habits.
  • Primary fecal incontinence exists whenchild has never achieved adequate bowel control; secondary fecalincontinence exists when child begins to soil after having achievedbowel control.

    • Principal Causes of Fecal Incontinence

    1. Maturationaldelay or developmental conflict
    2. Stress-related factors
    3. Constipation
    4. Neurologic disorders
      1. Mentalretardation
      2. Spinal dysraphism
      3. Spinal cord injury
      4. Spinal cord tumor
    5. Primary psychologic disturbance

    Clinical Features and Diagnosis

    Maturational Delay or Developmental Conflict

  • Some childrenexperience maturational delay in developing bowel control. Others havenever been toilet trained.
  • Sometimes developmental conflicts resultin fecal incontinence.
  • History and normal physical exam arediagnostic.

    • Stress-Related Factors

  • Stress iscommon cause of secondary fecal incontinence. Stress-related factorsinclude illness, separation, birth of sibling, attending new school,death of family member, parental divorce, or any other personalor family upset.
  • History and normal physical exam arediagnostic.

    • Constipation

  • Chronicconstipation from functional fecal retention is thought to be majorcause of encopresis, which is defined as fecal incontinence notresulting from illness or organic disorder.
  • Most cases of encopresis occur in school-agedchildren, who soil their underclothes.
  • See Chap.9, Constipation.

    • Neurologic Disorders

  • Childrenwith mild mental retardation may have delay in achieving bowel control, whilesome with severe retardation never achieve control.
  • Spinal dysraphism, spinal cord injury,or spinal cord tumor can be associated with fecal incontinence.

  • History andphysical exam, including rectal and neurologic exams, screen forthese disorders. Often there is history of lower extremity weakness,impaired sensation, and lack of bladder or bowel control. Strength,tone, sensation, and reflexes of lower extremities; back; anal sphinctertone; perianal sensation; and gait should be particularly examined.
  • Spine radiography, CT, and MRI locateand define extent of lesion.

    • Primary Psychologic Disturbance

  • Childrenwith severe behavioral disorders or psychosis may develop fecalincontinence.
  • History (including psychosocial historyof child and family), physical exam, clinical observation of child,and psychologic testing are diagnostic.

    • Diagnostic Approach

  • In childwith normal physical exam, most common causes of fecal incontinenceare maturational delay, developmental conflict, stress-related factors,and constipation. If primary psychologic disturbance exists, furtherevaluation should be performed by clinical psychologist or psychiatrist.
  • History and physical exam can screenfor a neurologic disorder. Relaxed anal sphincter tone, decreasedperianal sensation, lower extremity weakness, and urinary incontinencesuggest spinal cord lesion. Combination of spine radiography, CT,and MRI is usually diagnostic.

    • References

    1. Croffie JMB, Fitzgerald JF. Idiopathicconstipation. In: Walker WA, et al., eds. Pediatric gastrointestinaldisease, 3rd ed. Hamilton, Ontario, Canada: BC Decker, 2000:830–844.
    2. Rowe MI, et al. Essentials of pediatric surgery. St.Louis: Mosby-Year Book, 1995.
    3. Rudolph AM, ed. Rudolph's pediatrics, 20thed. Stamford, CT: Appleton & Lange, 1996.
    4. Tunnessen WW Jr. Signs and symptoms in pediatrics.3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999.

    Book Source Details

    • Book Title: The Diagnostic Approach to Symptoms and Signs in Pediatrics
    • Author(s): Paul S. Bellet
    • Year of Publication: 2006
    • Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2006 Lippincott Williams & Wilkins.

    Other Book Chapters Related to Fecal straining

    Read excerpts from these other book chapters related to Fecal straining:

    Medical Books Excerpts
    • DIARRHEA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • Diarrhea
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Diarrhea
    • "A Pocket Manual of Differential Diagnosis" (1999)
    • [ read ]
    • Constipation
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Diarrhea
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Constipation
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Diarrhea
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Diarrhea
    • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
    • [ read ]
    • Constipation
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Diarrhea
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Constipation
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Diarrhea
    • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
    • [ read ]
    • Diarrhea
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
     

    Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2008 Williams & Wilkins.

    More About Causes of Fecal straining



    More About This Book:
    Title: The Diagnostic Approach to Symptoms and Signs in Pediatrics
    Authors: Paul S. Bellet
    Publisher: Lippincott Williams & Wilkins
    Copyright: 2006
    ISBN: 0-78172-899-1

     » Next page: Constipation (Nursing: Interpreting Signs and Symptoms)

    Rate This Website

    What do you think about the features of this website? Take our user survey and have your say:

    Website User Survey

    Medical Tools & Articles:

    Next articles:

    Tools & Services:

    Medical Articles:

    Forums & Message Boards
     
    HONcode We subscribe to the HONcode principles

    By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.

    Home | Symptoms | Diseases | Diagnosis | Videos | Tools | Forum | About Us | Terms of Use | Privacy Policy | Site Map | Advertise

    Copyright © 2009 Health Grades Inc. All rights reserved.