What Are the Causes of Incontinence in Children?

Fecal incontinence in children (encopresis) refers to a functional digestive tract disease with abnormal fecal excretion after 4 years of age. It is mainly distinguished from the occasional uncontrolled stool in patients with diarrhea such as acute bacillary dysentery and acute enteritis.

Fecal incontinence in children

Fecal incontinence in children (encopresis) refers to a functional digestive tract disease with abnormal fecal excretion after 4 years of age. It is mainly distinguished from the occasional uncontrolled stool in patients with diarrhea such as acute bacillary dysentery and acute enteritis.

Visiting department

Children's Division

Multiple groups

child

Common locations

anus

Common causes

Congenital anal deformity, surgery, history of trauma, etc.

Common symptoms

Fecal incontinence

(I) Causes of Onset

Congenital malformation of the anus

(1) Nervous system development defect: Congenital lumbosacral meningocele or spina bifida may be associated with anal incontinence. The patient's external sphincter and puborectalis muscle lost normal innervation, had no contractile function, and were in a relaxed state. And because both the sensory and motor systems are affected, the rectal mucosa lacks a sense of swelling when the feces are full, and can not cause a sense of instinct and initiate defecation. The feces in the rectum are discharged at any time. Children with this disease are often accompanied by urinary incontinence.

(2) Anorectal deformity: The anorectal itself and the pelvic structure have changed, and the higher the blind rectum, the more obvious and complicated the change. When the high deformity is located above the pelvic ridge, the puborectalis is shortened, and it is obviously shifted forward and upward; the internal sphincter is absent or is only in the embryonic state; the external sphincter is mostly in a loose state, filled with adipose tissue, and the muscle fibers are abnormal. disorder. The authors followed up 225 cases of children with anorectal deformity after surgery. 80 cases (35.5%) had different degrees of fecal stool or incontinence. The higher the position of the deformity, the higher the incidence of incontinence. The etiology is mainly related to deformity accompanied by defects in sensory and motor nerve tissue structure, and it is also obviously related to surgical injury and surgical error. In the past, when the perineoplasty was performed in the treatment of high deformity, the rectum did not pass through the puborectalis annulus and descended behind it. Anorectal deformities, especially high malformations associated with zygomatic deformities, are not uncommon for neurological deficits. According to Jiehioiiikhh analysis, about 10% of postoperative anal incontinence is due to this. Anal incontinence after mid- and low-level deformity is mainly caused by surgical injury and infection. Such as cloaca abnormalities, mainly rectal anal canal, urethra, vagina, and high anal-free infants often have fecal incontinence after surgery. Fecal incontinence can occur in congenital dementia, meningocele, and multiple scleroderma.

2. Trauma The sphincter loses its sphincter function and causes fecal incontinence due to trauma damage to the anorectal ring. Such as stab wounds, cuts, burns, frostbite and lacerations (mainly perineal lacerations during childbirth), and injuries to anorectal surgery, such as anal fistula, hemorrhoids, rectal prolapse, rectal cancer and other injuries to the anus Incontinence caused by sphincter.

3. Nervous system lesions are more common in brain trauma, brain tumors, cerebral infarction, spinal cord tumors, spinal tuberculosis, and cauda equina nerve injury, which can cause fecal incontinence.

4. The most common anorectal disease is anorectal tumor; such as rectal cancer, anal canal cancer, Crohn's disease invades the anorectal rectum and affects the anal sphincter, or long-term diarrhea caused by ulcerative colitis. At this time, or anal relaxation caused by rectal prolapse, and severe scars around the anus affect the anal sphincter, which can cause fecal incontinence when the anus is incompletely closed.

(Two) pathogenesis

Fecal incontinence in children 1. Pathophysiological defecation is a coordinated and unified process involving multiple systems of the human body. The feces reach the rectum. First, the rectum must have a certain compliance. The feces are accepted, normally 250ml. After the rectum contents reach a certain amount, the rectal receptors are stimulated to enter the center through the afferent nerve fibers, and then reach the outside through the efferent nerve fibers. Sphincter and levator anus. The center determined that the conditions allowed. At this time, the external sphincter was relaxed and the intra-abdominal pressure increased to complete defecation. When defecation is not allowed for some reason, the external sphincter presses the internal sphincter through voluntary contraction, so that the internal sphincter retroreflectively inhibits rectal contraction, thereby expanding the rectum and increasing its volume, or pushing the stool back to the sigmoid colon through reverse rectal peristalsis. Will disappear. Such voluntary contraction of the external sphincter stimulates the reverse inhibition of rectal contraction of the internal sphincter. Defecation is a very complicated process, and damage to any link can cause fecal incontinence. If the rectal compliance is too low, it can lead to a serious increase in the number of stools, and even incontinence. If the compliance is too high, it can cause an increase in rectal volume and constipation. Fecal incontinence can also occur if the voluntary inhibition is reduced, as well as abnormal rectal receptors, or external sphincter damage. In short, there are many causes of fecal incontinence, which need to be further explored.

The diagnosis of this disease can be initially established through medical history analysis, including clinical manifestations and clinical analysis of the primary cause. The inspection showed that the anus had original surgery or trauma scar deformities, and fecal contamination. Anal finger examination shows anal canal relaxation or poor sphincter contractile function, and clinical diagnosis can be established. The primary cause of the disease is in the nervous system and colon, and it should be established through barium enema and endoscopy. In recent years, there have been some new developments in anorectal function tests, including abnormal muscle tension seen in electromyography, prolonged anal reflex latency, disappearance of anal skin reflex and normal rectal swelling. Anorectal balloon manometry showed abnormal pressure maps. Fecal X-rays can reveal the disappearance of the rectal angle of the anal canal. These tests can help distinguish lesions, etiology, and develop appropriate treatment methods.

1. Medical history asks if there is a history of congenital anal deformity, surgery, trauma, whether the female patient has a history of birth injury, whether there are neurological and urinary diseases, whether they have received radiation therapy; the current severity of incontinence, the frequency of defecation and the nature of stool , Whether there is a sense of inconvenience, etc.

2. Physical examination through digital rectal examination, endoscopy, defecography, electromyography, etc., to achieve 3 purposes:

Determine if there is anal incontinence, such as a defect in the anus, tight closure of the anal sphincter, and eczema on the skin around the anus.

Judging the degree of incontinence: if the incontinence is visible, the anus is open and round, and the hips are pulled apart, and the rectal cavity is visible; Incomplete incontinence is seen when the anus is not tightly closed, and the digital rectal diaphragm and sphincter contraction weaken.

Judging the cause of incontinence: such as traumatic incontinence, digital rectal examination can scab and scar tissue; voluntary muscle injury, abnormal pelvic floor electromyography, etc.

It is mainly distinguished from occasional loose stools in patients with diarrhea such as acute bacillary dysentery and acute enteritis. However, the stools of these patients can be controlled freely in most cases, and the patients often have abdominal pain, pus, blood or watery stools. After symptomatic treatment, With the relief of diarrhea symptoms, stool formation, and occasional stool incontinence disappeared. Fecal incontinence is mainly the identification of the causes, including neurological disorders and injuries, muscle dysfunction and impairment, and congenital diseases.

1. Insist on anal levitation exercise, 30 times in the morning and evening;

2. Massage Zusanli, Guan Yuan, Changqiang and other acupoints;

3. These therapies have a certain effect on anal incontinence.