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Bowel Management for the Treatment of Fecal Incontinence

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Surgical Treatment of Colorectal Problems in Children

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Abstract

Unfortunately, after the repair of anorectal malformations, many patients suffer from significant sequelae, and the most feared of those is fecal incontinence, followed by urinary incontinence and sexual problems. A critical analysis is presented of the different therapeutic methods that different authors use to deal with the sequelae including biofeedback, electrical stimulation, and behavior modification. At the end, the authors present the “bowel management program” used at their institution; this is a detailed description of the methodology that the authors believe allows to improve the quality of life of many fecally incontinent patients at a relatively low cost.

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Notes

  1. 1.

    Loperamide HCl 2 mg simethicone 125 mg (in each caplet) slows the rate at which the stomach and intestines move. It also increases the density of stools and reduces the amount of fluid in the stool.

  2. 2.

    MRI Peña/Patel protocol: The purpose of this study is to determine the position of the rectum in relationship to the sphincteric mechanism. We try to see if the rectum is anteriorly, posteriorly, or laterally mislocated, in relation to the sphincter mechanism. In addition, we look for other abnormalities such as posterior urethral diverticulum frequently found in these patients.

  3. 3.

    See footnote 2.

  4. 4.

    See footnote 1.

  5. 5.

    Castile soap – 0.30 fluid oz. packets (1 packet = 9 ml); mild, gentle soap ideal for soft soap enemas

  6. 6.

    Fleet – monobasic sodium phosphate 19 g, dibasic sodium phosphate 7 g

  7. 7.

    Dulcolax ® bisacodyl

  8. 8.

    See footnote 5.

  9. 9.

    See footnote 6.

  10. 10.

    See footnote 5.

  11. 11.

    See footnote 6.

  12. 12.

    See footnote 5.

  13. 13.

    See footnote 1.

  14. 14.

    See footnote 1.

  15. 15.

    See footnote 1.

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Authors and Affiliations

  1. Pediatric Surgery, Colorectal Center for Children Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Alberto Peña & Andrea Bischoff

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  1. Alberto Peña
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  2. Andrea Bischoff
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20.1 Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Animation showing the basic principles and rationale to the use of enemas. The enema cleans the colon in about 30–45 min. The new stool travels from the cecum to the rectum in more than 24 h. And therefore, the patient remains clean in between enemas (WMV 24480 kb)

Animation showing the effect of an enema in a patient with hypermotility. The enema cleans the colon, but the new stool travels from the cecum to the rectum in less than 24 h, and that is the reason why the patient passes stool in the underwear in between enemas (WMV 22496 kb)

Animation showing the management of patients suffering from fecal incontinence and colonic hypermotility. The enema cleans the colon, and the loperamide and the constipating diet slow down the colon to avoid “accidents” (passing stool in the underwear) in between enemas (WMV 16256 kb)

Animation showing the disimpaction process (WMV 37952 kb)

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Peña, A., Bischoff, A. (2015). Bowel Management for the Treatment of Fecal Incontinence. In: Surgical Treatment of Colorectal Problems in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-14989-9_20

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  • DOI: https://doi.org/10.1007/978-3-319-14989-9_20

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14988-2

  • Online ISBN: 978-3-319-14989-9

  • eBook Packages: MedicineMedicine (R0)

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