Fecal incontinence in children

Rome IV diagnostic criteria for gastrointestinal disorders of children and adolescents[1]Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016 May;150(6):1456-68. http://www.ncbi.nlm.nih.gov/pubmed/27144632?tool=bestpractice.com

H3: Functional defecation disorders

H3a: Functional constipation

• Must include 2 or more of the following occurring at least once per week for a minimum of 1 month and not fulfilling criteria for irritable bowel syndrome:

  • 2 or fewer defecations in the toilet per week in a child of developmental age of 4 years or older

  • 1 episode or more of fecal incontinence per week

  • History of retentive posturing or excessive volitional stool retention

  • History of painful or hard bowel movements

  • Presence of large fecal mass in rectum

  • History of large-diameter stool that clogs the toilet.

• The criteria also include the stipulation that after appropriate evaluation, the symptoms cannot be explained by another condition.

H3b: Nonretentive fecal incontinence

• Must include at least a 1-month history of the following symptoms in a child of developmental age of 4 years or older:

  • Defecation into places deemed inappropriate to the socio-cultural context

  • No evidence of fecal retention.

• The criteria also include the stipulation that after appropriate evaluation, the symptoms cannot be explained by another condition.