FECAL INCONTINENCE IN CHILDREN

Functional constipation is the cause of fecal incontinence in 95 perce nt of affected children, and anatomic or neurologic causes account for up to 5 percent of cases. The history and the physical examination (w ith emphasis on abdominal, rectal and neurologic examinations) are mos t helpful in identifying organic disease. in some children, anorectal manometry, a barium enema radiographic examination and a rectal biopsy are necessary to determine the etiology. Most children with fecal inc ontinence benefit from a strict treatment plan that includes defecatio n trials, a fiber-rich diet and laxative medications. Surgery followed by medical treatment is required in patients with Hirschsprung's dise ase and in some patients with anal stenosis or a history of surgical r epair of an anorectal malformation.