Management of

Fecal Incontinence
Andrea Bischoff
January 21st, 2021
Dilated Colon
Non-dilated Colon
Importance of Abdominal Radiograph
Patient born and operated on because of
total colonic aganglionosis comes to see you
about fecal incontinence and diaper rash.
 What do you recommend?
1. Enemas
2. Imodium (loperamide)
3. Fiber
4. Examination under anesthesia
5. Options 1, 2, and 3
 Take-home message
• Evaluation of the integrity of the anal canal is
important to determine treatment in patients with
Hirschsprung or Total Colonic Aganglionosis.
• Enemas are to clean the colon; they should not be
used in the small bowel.
• Hirschsprung + damaged anal canal = fecal
incontinence = enema
• Total Colonic Aganglionosis + damaged anal canal =
fecal incontinence = ileostomy
5 yo female patient with spina bifida
What treatment do you propose?
1. Normal saline enema (high
volume and high concentration)
2. Normal saline enema only
3. Tap water enema
4. Fleet enema
5. I don’t know
This patient final solution was 450 ml
of normal saline + 40 ml of glycerin
 Take-home message
• Patients with spina bifida have a redundant
nondilated colon, but they are usually very
hypomotile – need high volume and high
concentration.
• Function of the colon is to absorb water – we
prefer normal saline with irritants.
• Challenge in patients with spina bifida is the
lack of sphincter tone (leakage of solution).
 3 yo female patient born and
operated on for a vestibular fistula
What treatment do you propose?

1.Laxatives
2.Enemas
3.Fiber
4.I don’t know
 Take-Home Message

In anorectal malformation the sacral ratio +

type of anomaly gives you an indication about
prognosis for bowel control
• 5 yo male patient with unknown type
of anorectal malformation, operated
on in another country, and later
adopted by American parents.
• Flat bottom, abnormal sacrum.
• Unsuccessful toilet training.
What treatment do you propose?
1. Enemas initially with laxative
trial in the future
2. Enemas and Malone procedure
in the future
3. I don’t know
 We started him on 400 ml of
normal saline + 20 ml of glycerin
Do you think the enema is cleaning
his colon?
1. Yes
2. No
3. I don’t know
If parents reported stool accidents
with this current abdominal
radiograph, what would you do?
1. Increase the concentration of the enema
2. Decrease the concentration of the enema
3. Add Imodium (loperamide)
4. I don’t know
Patient came for laxative trial (x2)
but was not successful.
 6 yo male patient born and
operated on for anorectal
malformation in another country
Patient was started on 200 ml of
normal saline + 15 ml of glycerin
Parents reported stool accidents
throughout the day, what would
you do?
1. Increase to 400 + 20 of glycerin
2. Add Imodium
3. I don’t know
Patient was clean on 200 ml of
normal saline + 15 ml of glycerin
+ 15 ml of Imodium 2x/day
Patient failed laxative trial
Antegrade versus
Retrograde Enema