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Fecal Incontinence
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
The surgeon's obligation with cloacal exstrophy newborns is to separate GI tissue from urinary tissue, incorporate all GI tissue into a single tube, and open an end colostomy. — Peña, Anorectal Malformations: Introduction and Overview for bowel management · 22:37
Fecal Incontinence Bowel Management: Pediatric Bowel Management 2013
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During the Pediatric Bowel Management Course in 2013,directors DrsAndrea Bischoff, Alberto Peña and Todd Ponsky discusscontroversial/hot topics surrounding the management and diagnosis of pediatric bowel conditions.In this session, Dr. Andr
video1:25:01 · Jan 2019
Anorectal Malformations: Introduction and Overview for bowel management
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Join our symposia directors Andrea Bischoff, Alberto Peña and Todd Ponsky for this live video webcast and global discussion covering a wide range of topics related to diagnosis and management of fecal incontinence, constipation and stoma ma
video26:08 · Jan 2019
If the enema volume reaches the cecum, it should be as effective at cleaning the whole colon as a Malone antegrade enema. — Stephanie, Bowel Management - Use Of Ultrasound To Monitor Effects Of Enema · 10:30
Bowel Management - Use Of Ultrasound To Monitor Effects Of Enema
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video12:53 · Nov 2018
Use of hydrocolonic sonography to monitor the effects of an enema: Pediatric...
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During the Pediatric Bowel Management Course in 2013,directors DrsAndrea Bischoff, Alberto Peña and Todd Ponsky discusscontroversial/hot topics surrounding the management and diagnosis of pediatric bowel conditions.In this session, Dr. Stef
video12:46 · Jan 2019
On admission, an abdominal x-ray is obtained to check for fecal impaction; if impacted, enemas are given until disimpaction is confirmed by x-ray before starting bowel management. Bowel Management - Bowel Management In Communities With Limited Resources · 4:40
Bowel Management - Bowel Management In Communities With Limited Resources
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video9:14 · Nov 2018
These anatomic problems (patulous anus and absent dentate line) result from an overstretching of the anal sphincters and a dissection started too low during the initial procedure. Sphincter Reconstruction for Patients with Soiling after a Pull-Through for Hirschsprung Disease · 0:25
Sacral Nerve Stimulator Placement: A Novel Surgical Navigation Tool for...
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This video demonstrates an image-guided technique for sacral nerve stimulator insertion by Dr. Jason Frischer at Cincinnati Children's Hospital Medical Center in Cincinnati, OH. This type of neuromodulation is used as an adjunct in the mana
video4:59 · Jul 2019
Sphincter Reconstruction for Patients with Soiling after a Pull-Through for Hirschsprung Disease
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Sphincter reconstruction technique is described in detail for patients with soiling due to an iatrogenic overstretching of the anal sphincters at the time of the initial pull-through procedure for Hirschsprung disease. Until this technique,
video5:04 · Oct 2022
Update Course Rewind 2025: Sacral Nerve Stimulation for Refractory Pediatric Fecal Incontinence
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This video, featuring Dr. P. Ben Ham III, discusses sacral nerve stimulation (SNS) as a treatment option for children with severe fecal incontinence and constipation refractory to conventional medical therapies. It presents a clinical scena
video2:37 · Jul 2026
Colorectal Quiz Episode 37: The Yancey-Soave story of the original surgical descriptions for Hirschsprung disease
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Swenson described the first operation for Hirschsprung disease in the 1940s, which involved a full thickness rectal dissection. To respond to complications related to the dissection adjacent to the rectal wall, several surgeons came up with
podcast20:08 · Apr 2023
The identified muscle complex was tacked to the posterior rectum so that when these muscles contract, the rectum will be pulled in and closed. Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene · 2:01
Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene
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Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
video5:47 · Mar 2026
Expert statements from the recordings in this collection.
Fecal Incontinence Bowel Management: Pediatric Bowel Management 2013
True fecal incontinence patients lack bowel control ability either congenitally or from acquired damage; pseudo incontinence is constipation with overflow soiling.
Congenital true incontinence includes myelomeningocele, large sacrococcygeal tumors, absent sacrum, and anorectal malformations with sacral ratio <0.4, presacral mass, or tethered cord.
Acquired true incontinence occurs in Hirschsprung patients with damaged anal canal or ARM patients with good prognosis who had complications (dehiscence) requiring reoperation.
Treatment for true fecal incontinence is enema to artificially clean the colon and prevent bowel movements for 24 hours.
Pseudo fecal incontinence patients have bowel control ability but suffer from constipation; treatment is laxatives, not enemas.
A sacral ratio less than 0.4 predicts true fecal incontinence.
Removing a presacral mass does not improve continence because the nerve damage from the sacral defect is the cause of incontinence, not the mass itself.
Presacral masses must be resected because they can cause infection leading to meningitis or may be malignant, not to improve continence.
If a presacral mass causes severe rectal compression and stricture, removing the mass does not cure the stricture; the stricture area must be resected and normal rectum pulled through.
Tethered cord release does not improve bowel control; some neurosurgeons believe it may help bladder function, but this is controversial.
Expert opinion10:28
There is no scientific consensus on tethered cord management; some neurosurgeons operate aggressively, others do not, and outcomes vary widely regardless of intervention.
Expert opinion12:47
Contrast enema without bowel prep reveals two patient groups: dilated colon (slow motility) and non-dilated colon (hypermotility).
Dilated colon patients need large-volume, concentrated enemas to clean but the colon stays quiet for 23 hours afterward.
Non-dilated (hypermotile) colon patients need small-volume saline enemas plus loperamide, fiber, and constipating diet to keep the colon quiet.
Enema base is saline 200–1000 mL; irritants are liquid glycerin 10–30 mL, Castile soap 9–36 mL, and phosphate (Fleet) as last resort due to risk of colitis.
Fleet enema doses: ages 3–4 years use half pediatric Fleet (33 mL), 4–10 years one pediatric Fleet (66 mL), over 10 years adult Fleet (133 mL) to avoid electrolyte disturbances.
Enema titration is a one-week trial-and-error process monitored by daily abdominal X-rays; the goal is a clean left colon and rectum post-enema.
Never give laxatives and enemas simultaneously in fecal incontinence patients; laxatives cause unpredictable bowel movements after the enema, worsening incontinence.
If underwear is soiled and X-ray shows stool in left colon, increase enema volume or concentration.
If enema takes over 1 hour to produce bowel movement, increase concentration to make it more irritant.
If patient has pain, nausea, or vomiting during enema with clean X-ray, decrease concentration; if X-ray not clean, slow administration and warm solution instead.
If colon is clean on X-ray but patient still has accidents, the colon is hypermotile; add loperamide and constipating diet.
Bowel management is about quality of life determined by the patient, not the doctor; some patients prefer managing through a stoma rather than undergoing pull-through.
Expert opinion44:55
Malone procedure should only be offered after demonstrating that enema works; doing Malone without prior bowel management trial is incorrect.
Expert opinion50:53
Saline is used as enema base instead of tap water because the colon absorbs water, risking electrolyte disturbances.
Saline-only enemas often fail to produce bowel movements; irritants (glycerin, soap) are needed to provoke colonic contraction.
For fecal impaction, disimpact with three concentrated enemas per day, not saline-only enemas.
When evaluating post-enema X-rays, focus on left colon and rectum; stool in transverse or right colon is acceptable as it takes 24 hours to reach the rectum.
Myelomeningocele patients typically have non-dilated or redundant colons on contrast enema, not dilated colons, even when constipated and incontinent.
Neuronal intestinal dysplasia (NID) lacks scientific validity: no topographic studies define disease extent, no standard treatment exists, and pathologists disagree on diagnosis.
Expert opinion22:34