Fecal incontinence in children.

Functional constipation is the cause of fecal incontinence in 95 percent of affected children, and anatomic or neurologic causes account for up to 5 percent of cases. The history and the physical examination (with emphasis on abdominal, rectal and neurologic examinations) are most 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 incontinence benefit from a strict treatment plan that includes defecation trials, a fiber-rich diet and laxative medications. Surgery followed by medical treatment is required in patients with Hirschsprung's disease and in some patients with anal stenosis or a history of surgical repair of an anorectal malformation.