This uncommissioned review article was subject to full peer-review.
Review article: faecal incontinence in children: epidemiology, pathophysiology, clinical evaluation and management
Article first published online: 28 OCT 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 37, Issue 1, pages 37–48, January 2013
How to Cite
Rajindrajith, S., Devanarayana, N. M. and Benninga, M. A. (2013), Review article: faecal incontinence in children: epidemiology, pathophysiology, clinical evaluation and management. Alimentary Pharmacology & Therapeutics, 37: 37–48. doi: 10.1111/apt.12103
- Issue published online: 4 DEC 2012
- Article first published online: 28 OCT 2012
- Manuscript Accepted: 2 OCT 2012
- Manuscript Revised: 30 SEP 2012
- Manuscript Revised: 23 MAY 2012
- Manuscript Received: 5 MAY 2012
Faecal incontinence (FI) in children is a significant gastrointestinal problem, with great personal and social impacts. It is characterised by recurrent loss of faecal matter into the underwear. Both functional and organic causes contribute to its aetiology with the former predominating.
To review the epidemiology, pathophysiology, clinical evaluation and management of functional faecal incontinence in children.
A PubMed search was conducted using search terms f(a)ecal incontinence, and encopresis. Articles on epidemiology, pathophysiology, clinical evaluation, investigation and management of functional FI in children were retrieved and assessed.
Community prevalence of this distressing problem ranges from 0.8% to 7.8% globally. Male: female ratio varies from 3:1 to 6:1. The diagnosis of FI is often based on established clinical criteria. The majority (82%) have constipation associated functional FI. Biopsychosocial factors play a crucial role in the pathogenesis. Limited physiological testing of anorectal function is recommended in the diagnostic procedures, particularly in children with atypical symptoms and possible organic disorders. Management of FI needs a multidisciplinary approach which includes establishment of an effective doctor-patient partnership, understanding the underlying mechanisms, pharmacotherapy and behavioural treatment. Approximately 15% of children with functional nonretentive faecal incontinence (FNRFI) had the same symptoms at the age of 18 years.
Significant therapeutic advances have been made for retentive faecal incontinence, but treatment options for functional nonretentive faecal incontinence are limited. Limited long-term outcome data show that the majority outgrow faecal incontinence. A substantial proportion of children progress to adulthood with faecal incontinence.