Fecal Incontinence in Children – an OT/PT Approach

Fecal incontinence in children is a problem that can cause a great deal of embarrassment and social isolation. It can also lead to physical problems if not treated. Occupational and Physical Therapy can sometimes help to improve the situation for these children.

There are a number of different causes of fecal incontinence in children. It can be the result of an anatomical problem, such as an anal fissure or an imperforate anus. It can also be caused by a neurological condition, such as spina bifida or cerebral palsy. In some cases, it may be the result of chronic constipation.

Pseudoincontinence or encopresis typically occurs in children who are able to use the toilet but have developed severe, chronic constipation. This happens when stools become infrequent or hard to pass.

Most children who have fecal incontinence can be successfully treated with dietary changes, stool softeners, and/or enemas. In some cases, surgery may be necessary to correct an anatomical problem. For some children, physical or occupational therapy may help to improve muscle control and reduce the risk of soiling accidents.

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WHAT DOES IT MEAN TO BE TOILET TRAINED FOR BOWEL MOVEMENTS?

When children have control over their bowel movements, the body needs three things to work together: voluntary muscle control, the ability to sense the need to go and involuntary movements that push the stool along to exit the body.

If something goes wrong with just one part of the process, it can cause bowel problems like constipation or fecal incontinence.

WHAT DOES THE RESEARCH SAY ABOUT FECAL INCONTINENCE IN CHILDREN AND OT/PT?

Physical and Occupational Therapy in Pediatrics published a case study on an interdisciplinary approach to managing constipation and fecal incontinence in children. This study included a retrospective chart review, surface electromyography (sEMG) biofeedback, and parent and child reports of progress. The participants were two children ages 4 and 10 years old.

To measure progress, a therapy plan of care was implemented with progress updates every 60 days. The goals included the following:

pelvic floor muscle coordination and activation
education of anatomy and physiology of the digestive system
emotional regulation
functional training in the bathroom
hygiene.

The study found that over a 6-month period, there were improvements in pelvic floor function, emotional regulation, and defecation dynamics. These improvements led to decreased constipation and fecal incontinence as well as improved emotional regulation and confidence in both participants.

The researchers found that physical therapy and occupational therapy can help with constipation and fecal incontinence in children. This can help them be successful in reaching full continence.

Reference: Osborn, H., Reek, S., & Anderson, B. (2022). Interdisciplinary Occupational and Physical Therapy Approach to Treating Constipation and Fecal Incontinence in Children. Physical & Occupational Therapy In Pediatrics, 1-14.