Fecal Incontinence
Everything in the library about fecal incontinence — built automatically from the recorded discussions that name it
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
Fundamentals
2 items
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
video85:01 · 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
Diagnosis & Workup
1 item
Bowel Management - Use Of Ultrasound To Monitor Effects Of Enema
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video12:53 · Nov 2018
Medical Management
1 item
Bowel Management - Bowel Management In Communities With Limited Resources
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video9:14 · Nov 2018
Surgical Management
1 item
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
Evidence & Research
1 item
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
Case-Based Learning
1 item
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
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
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.
clinical0:00 ↗
Congenital true incontinence includes myelomeningocele, large sacrococcygeal tumors, absent sacrum, and anorectal malformations with sacral ratio <0.4, presacral mass, or tethered cord.
clinical0:39 ↗
Acquired true incontinence occurs in Hirschsprung patients with damaged anal canal or ARM patients with good prognosis who had complications (dehiscence) requiring reoperation.
clinical2:24 ↗
Treatment for true fecal incontinence is enema to artificially clean the colon and prevent bowel movements for 24 hours.
clinical3:37 ↗
Pseudo fecal incontinence patients have bowel control ability but suffer from constipation; treatment is laxatives, not enemas.
clinical3:49 ↗
A sacral ratio less than 0.4 predicts true fecal incontinence.
clinical5:12 ↗
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.
clinical7:39 ↗
Presacral masses must be resected because they can cause infection leading to meningitis or may be malignant, not to improve continence.
clinical8:52 ↗
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.
clinical8:04 ↗
Tethered cord release does not improve bowel control; some neurosurgeons believe it may help bladder function, but this is controversial.
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.
opinion12:47 ↗
Contrast enema without bowel prep reveals two patient groups: dilated colon (slow motility) and non-dilated colon (hypermotility).
clinical33:36 ↗
Dilated colon patients need large-volume, concentrated enemas to clean but the colon stays quiet for 23 hours afterward.
clinical34:23 ↗
Non-dilated (hypermotile) colon patients need small-volume saline enemas plus loperamide, fiber, and constipating diet to keep the colon quiet.
clinical34:55 ↗
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.
clinical35:57 ↗
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.
clinical37:04 ↗
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.
clinical37:28 ↗
Never give laxatives and enemas simultaneously in fecal incontinence patients; laxatives cause unpredictable bowel movements after the enema, worsening incontinence.
clinical39:27 ↗
If underwear is soiled and X-ray shows stool in left colon, increase enema volume or concentration.
clinical40:21 ↗
If enema takes over 1 hour to produce bowel movement, increase concentration to make it more irritant.
clinical41:24 ↗
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.
clinical41:54 ↗
If colon is clean on X-ray but patient still has accidents, the colon is hypermotile; add loperamide and constipating diet.
clinical43:46 ↗
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.
opinion44:55 ↗
Malone procedure should only be offered after demonstrating that enema works; doing Malone without prior bowel management trial is incorrect.
opinion50:53 ↗
Saline is used as enema base instead of tap water because the colon absorbs water, risking electrolyte disturbances.
clinical61:34 ↗
Saline-only enemas often fail to produce bowel movements; irritants (glycerin, soap) are needed to provoke colonic contraction.
clinical62:04 ↗
For fecal impaction, disimpact with three concentrated enemas per day, not saline-only enemas.
clinical62:40 ↗
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.
clinical63:20 ↗
Myelomeningocele patients typically have non-dilated or redundant colons on contrast enema, not dilated colons, even when constipated and incontinent.
clinical20:23 ↗
Neuronal intestinal dysplasia (NID) lacks scientific validity: no topographic studies define disease extent, no standard treatment exists, and pathologists disagree on diagnosis.
opinion22:34 ↗
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