Fecal incontinence is the inability to control bowel movements. This condition can affect patients who were born with Hirschsprung's disease, anorectal malformation, pelvic tumors, spina bifida, sacral agenesis, or those with severe pelvic trauma. Children with this problem may have difficulty in social relationships due to their condition.
How do I know if my child has fecal incontinence?
Patients with fecal incontinence make involuntary stools, they can not control the output of feces. Children with true fecal incontinence do not have the ability to make voluntary bowel movements, either because they were born with a malformation that prevents them from having an intestinal control, or because they have lost the integrity of the anal canal after trauma or surgery.
Is fecal incontinence the same in all patients?
Fecal incontinence is not the same in all patients. We could divide incontinence into two large groups: some patients have fecal incontinence with a tendency to constipation and a second group has fecal incontinence with a tendency to diarrhea. It is important to determine what type of incontinence the child has before starting targeted treatment. The opaque enema is a very useful diagnostic test to differentiate one from the other.
How can I help my child with fecal incontinence?
A patient with fecal incontinence benefits from an Intestinal Management Program. The goal of this program is for the patient to be clean for 24 hours and to be able to wear normal underwear without the use of diapers. These patients do not have the ability to control bowel movements or perform voluntary bowel movements. The way the colon is clean and free of leaks is through colorectal enemas that empty the colon. Generally, patients who have a tendency to constipation do not need medication or a special diet, the colon moves slowly allowing them to be clean for 24 hours after the enema. In contrast, children with incontinence prone to diarrhea will need low-volume enemas and medication to slow the movement of the colon.
How does the Intestinal Management Program work?
Initially, a review of the patient's medical history is performed based on the pathology:
- Anorectal malformation: types of malformation, types of intervention and complications, associated malformations, etc.
- Hirschsprung's disease: length of the affected segment, type of intervention and complications, etc.
In some cases an examination under general anesthesia will also be necessary:
- In patients with anorectal malformation to assess the position of the anus with respect to the muscle complex.
- In patients with Hirschsprung, a biopsy could be performed to determine the presence of lymph node cells in the segment of the descended intestine. It is also important to assess the anatomy of the anal canal and see where the anastomosis (surgical junction of the bowel) has been performed.
The next step is to perform an opaque enema to determine:
- In patients with Hirschsprung: length of the remaining intestine, presence of colitis, diameter and motility of the descended segment, etc.
- In other patients: diameter of the colon and motility of the colon.
Once you have all this information, you can start a program of personalized colorectal enemas in order to keep the child clean.
What are colorectal enemas?
Enemas are used to artificially empty the colon. It consists of inserting a probe through the rectum to administer a solution that helps clean the colon, facilitating the exit of feces, and keep the child free of accidents for 24 hours. Before starting to make the enemas, the necessary information is given where it is explained what the necessary material is and how to administer it by a member of the team (pediatric surgeon or nurse). The individualized "recipe" for the enema that your child will need will also be given.
Are there any surgeries that can help my child?
Yes, in selected cases in which the Intestinal Management Program has been shown to be effective, surgery may be offered. These patients may have an appendicostomy or a neo-appendicostomy. In this operation, the appendix, or a segment of the large intestine, connects to the skin of the navel creating a stoma. This stoma allows the passage of a small catheter to the colon, and so they can make the enema while sitting in the bathroom. This procedure allows the child to be independent, improving the quality of life of these patients.