Fecal Incontinence
in Children

If your child has fecal incontinence, you need to see a doctor to determine the cause and treatment. Fecal incontinence can occur in children because of a birth defect or disease, but in most cases it's because of chronic constipation.

Potty-trained children often get constipated simply because they refuse to go to the bathroom. The problem might stem from embarrassment over using a public toilet or unwillingness to stop playing and go to the bathroom. But if the child continues to hold in stool, the feces will accumulate and harden in the rectum. The child might have a stomachache and not eat much, despite being hungry. And when he or she eventually does pass the stool, it can be painful, which can lead to fear of having a bowel movement.

A child who is constipated may soil his or her underpants. Soiling happens when liquid stool from farther up in the bowel seeps past the hard stool in the rectum and leaks out. Soiling is a sign of fecal incontinence. Try to remember that your child did not do this on purpose. He or she cannot control the liquid stool and may not even know it has passed.

The first step in treating the problem is passing the built-up stool. The doctor may prescribe one or more enemas or a drink that helps clean out the bowel, like magnesium citrate, mineral oil, or polyethylene glycol.

The next step is preventing future constipation. You will play a big role in this part of your child's treatment. You may need to teach your child bowel habits, which means training your child to have regular bowel movements. Experts recommend that parents of children with poor bowel habits encourage their child to sit on the toilet four times each day (after meals and at bedtime) for 5 minutes. Give rewards for bowel movements and remember that it is important not to punish your child for incontinent episodes.

Some changes in eating habits may be necessary too. Your child should eat more high-fiber foods to soften stool, avoid dairy products if they cause constipation, and drink plenty of fluids every day, including water and juices like prune, grape, or apricot, which help prevent constipation. If necessary, the doctor may prescribe laxatives.

It may take several months to break the pattern of withholding stool and constipation. And episodes may occur again in the future. The key is to pay close attention to your child's bowel habits. Some warning signs to watch for include:

     *	pain with bowel movements
     *	hard stool
     *	constipation
     *	refusal to go to the bathroom
     *	soiled underpants
     *	signs of holding back a bowel movement, like squatting, 
        crossing the legs, or rocking back and forth

     *	They were potty-trained too early.
     *	They refuse to have a bowel movement (because of painful 
        ones in the past, embarrassment, stubbornness, or even a 
        dislike of public bathrooms).
     *	They are in an unfamiliar place.
     *	They are reacting to family stress like a new sibling or 
        their parents' divorce.
     *	They can't get to a bathroom when they need to go so 
        they hold it. As the rectum fills with stool, the child 
        may lose the urge to go and become constipated as the 
        stool dries and hardens.