Fecal incontinence in children

Introduction Children's fecal incontinence (encopresis) refers to a functional digestive tract disease that still has abnormal fecal excretion after 4 years of age. Look at the child's spine problem, whether there is abnormal gastrointestinal imbalance, brain development problems, for some reason, when the bowel movement is not allowed, the external sphincter compresses the internal sphincter by random contraction, so that the internal sphincter reverse-reflexive inhibition of rectal contraction Thus, the rectum is dilated, the volume is increased, or the feces are pushed back to the sigmoid colon by the reverse peristalsis of the rectum, and the intention disappears. Such reversal inhibition of the internal sphincter by the external contraction of the external sphincter inhibits rectal contraction and is called random inhibition. Defecation is a very complicated process, and any damage to one link can cause incontinence.

Cause

(1) Causes of the disease

1. Anal congenital malformation

(1) Defects in the development of the nervous system: congenital lumbosacral sacral swelling or spondylolisthesis may be associated with anal incontinence. The patient's external sphincter and puborectalis muscle lose normal nerve innervation, have no contractile function, and are in a state of relaxation. And because the sensory and motor system are affected, the rectal mucosa lacks the sense of swelling when the feces are filled, and can not cause the intention and initiate the defecation movement, and the feces in the rectum are discharged at any time. This type of sick child is often accompanied by urinary incontinence.

(2) Anorectal malformation: The anorectal itself and the pelvic structure change, and the higher the rectal blind end, the more obvious the change and the more complicated. When the high position is deformed, the blind end of the rectum is located above the pelvis, the puborectal muscle is shortened, and it is obviously displaced forward and upward. The internal sphincter is missing or only in the rudimentary state. The external sphincter is mostly loose, and it is filled with adipose tissue, and the muscle fiber is abnormally disordered. .

2. Trauma

As a result of trauma, the anorectal ring is damaged, causing the sphincter to lose its sphincter function and to incontinence. Such as stab wounds, cuts, burns, frostbite and lacerations (mainly for perineal tears during maternal delivery), as well as injuries to anorectal surgery, such as anal fistula, hernia, rectal prolapse, rectal cancer, etc. The sphincter causes incontinence in the stool.

3. Nervous system lesions

More common in brain trauma, brain tumors, cerebral infarction, spinal cord tumors, spinal tuberculosis, cauda equina injury, etc. can lead to fecal incontinence.

an examination

Related inspection

EMG pelvic floor electromyogram

1. Medical history: ask whether there is congenital anal malformation, history of surgery, trauma, female patients with or without history of infection, whether there are diseases of the nervous system and urinary system, whether they have received radiation therapy, the severity of incontinence, the number of bowel movements and feces Nature, whether or not there is a sense of convenience.

2. Physical examination: through digital rectal examination, endoscopy, defecation angiography, electromyography, etc., to achieve three purposes:

1 to determine whether there is anal incontinence, such as anal defects, anal sphincter closure is not tight, perianal skin with eczema, etc. can provide anal incontinence.

2 to determine the degree of incontinence: such as complete incontinence can be seen that the anus is open and round, with the hand to open the buttocks, visible rectal cavity, rectal examination, anal sphincter and anorectal ring contraction is not obvious, especially serious disappear completely. Incomplete incontinence, the anus is not tightly closed, and the rectal examination and sphincter contraction are weakened.

3 to determine the reasons for incontinence: such as traumatic incontinence, rectal examination can be scar and scar tissue, voluntary muscle injury, pelvic floor EMG abnormalities.

Differential diagnosis

It is mainly related to the occasional loss of control of stool in patients with diarrhea such as acute bacillary dysentery and acute enteritis, but the stool of these patients can be controlled freely in most cases, and patients often have abdominal pain and pus and bloody stools or watery stools. The relief of diarrhea symptoms, stool formation, and occasional fecal incontinence disappeared. Fecal incontinence is mainly the identification of the cause, including neurological disorders and injuries, muscle dysfunction and damage, congenital diseases.

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