Fecal incontinence and constipation in children: a clinical conundrum.

Syed Rehan Ali, Shakeel Ahmed , Maqbool Qadir, Khadija N. Humayun Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan. Email: [email protected] Constipation is the infrequent passage of hard stools with pain and difficulty. It is one of the most common pediatric problems parents and healthcare providers face. A significant number of children, especially of the younger age group, are referred to specialists because of constipation. Fecal incontinence is almost always associated with constipation, which leads to marked loss of self esteem among children. The majority of cases of constipation and fecal incontinence are secondary to functional disorders, rather than organic causes and result in behavioral problems, which affect the social life of the child, as well as the family. Previously, it was believed that constipation and fecal incontinence were actually secondary to underlying psychological problems. Studies have failed to prove that psychological abnormalities are etiological factors for constipation among children; chronic constipation probably leads to behavioral abnormalities and also affects the family dynamics. The important causes of constipation and fecal incontinence, their impact on the child and the family, as well as various treatment modalities available are discussed in this article, which also emphasizes the importance of history and physical examination. Fecal incontinence is a common problem among children. The significance of the problem is often underestimated by medical practitioners. Chronic constipation with fecal incontinence is reported to account for 3% of referrals to pediatric clinics in teaching hospitals. In reality, constipation and fecal incontinence in a child are major problems for parents. Fecal incontinence results in marked loss of self esteem in children. Parents who assume that fecal incontinence is an intentional behavior may become angry and aggressive, often resulting in disruption of the relationship between parents, as well as between parents and their children.1 These children often become very frightened as they are punished for something which the majority of them have no control over. In the past, there was a tendency to attribute fecal incontinence in childhood to an underlying psychological disorder. However, studies have failed to identify the presence of underlying psychological abnormalities as the cause of fecal incontinence. On the contrary, there is evidence to suggest that many of the associated behavioral abnormalities are the result and not the cause of fecal incontinence. Resolution of behavioral problems Received: 11 Jun 2011/ Accepted: 06 Aug 2011 © OMSB, 2011