Fecal incontinence in children - Emerging treatments

Plugs for containing fecal incontinence

Limited data are available for the efficacy and tolerability of plugs for the treatment of fecal incontinence in children.[37]

Prucalopride

Prucalopride is a serotonin receptor agonist with enterokinetic properties. In a multicentered, randomized, placebo-controlled phase 3 trial, chronically constipated adult patients treated with prucalopride had significantly higher quality-of-life scores and improved bowel movements compared with placebo.[38] However, another multicenter, randomized, placebo-controlled phase 3 trial in children (6 months to 18 years old) with functional constipation found prucalopride was not more effective in increasing stool frequency or decreasing fecal incontinence frequency compared to placebo.[39] Further trials are ongoing.[40]

Lubiprostone

Lubiprostone is a novel selective chloride channel-2 activator that increases fluid secretion in the intestinal apical cell membrane, increasing gut motility and frequency of stool passage. Two phase 3 trials in adults with irritable bowel revealed efficacy in spontaneous bowel movement frequency and stool consistency. The beneficial effects lasted up to 4 weeks after treatment with lubiprostone was stopped.[41] Despite its efficacy in adults, lubiprostone did not demonstrate statistically significant effectiveness over placebo in children and adolescents with functional constipation in two phase 3 trials.[42] The safety profile was similar to that in adults. Despite its efficacy in adults, lubiprostone did not demonstrate statistically significant effectiveness over placebo in children and adolescents with functional constipation in two phase 3 trials.[42] The safety profile was similar to that in adults.

Intrasphincteric onabotulinumtoxinA

Intrasphincteric injection of onabotulinumtoxinA (formerly known as botulinum toxin A) has been reported to have variable effects in children with chronic constipation with internal anal sphincter dysfunction. A retrospective review of 24 pediatric patients with intractable constipation found that in half of them constipation improved for at least 6 months after treatment with intrasphincteric botulinum toxin.[43] In 15 children (mean age 7.8 years) with myelomeningocele and refractory neurogenic detrusor overactivity, fecal incontinence was alleviated with intravesical electromotive onabotulinumtoxinA administration in 10 (83.3%) of the 12 patients.[44] Additionally, a retrospective review of pediatric patients with various defecation disorders undergoing intrasphincteric botulinum toxin administration concluded that botulinum toxin injections appear safe, though the precise dosing and age at which complications are more likely to arise could not be ascertained and requires further study.[45]

Surgical intervention

The removal of a nonfunctioning area of the gut is still under investigation and is considered only after continued failure of medical management. A retrospective chart review of 19 chronically constipated children who underwent surgery after abnormal colonic and anorectal manometry found that 89% of parents felt the symptoms were completely resolved after surgery.[46]

Transanal irrigation

This procedure has been found to improve fecal continence in children with spina bifida.[47] One retrospective study of 147 children whose fecal incontinence and constipation failed to respond to conservative treatment found that a transanal irrigation device significantly improved symptoms in all patients.[48]