Constipation and Faecal Incontinence
Definitions
Constipation refers to the experience of stools that are firm and difficult to pass, or is associated with pain, or are happening infrequently.
Constipation can be from many causes, including medical illnesses, and surgical conditions such as Hirschprungs disease and anorectal malformations or anterior anus. There may also be underlying abnormalities of colonic motility.
Functional constipation is a type of constipation where there is no discernible abnormality of anatomy or colonic motility.
The Rome IV Criteria defines functional constipation as 1 month of at least 2 of;
≤2 stools per week
A history of withholding behaviour, or volitional stool retention
Painful or hard bowel motions
Large diameter stools
A large fecal mass in the rectum
1 episode per week of incontinence in a toilet trained child.
Faecal incontinence is the involuntary passage of stool. It may be true faecal incontinence when it is associated with an underlying problem such as spinal injuries, anorectal malformations, and Hirschprungs disease, because there is a lack of key anatomic elements to give bowel control.
In Pseudo-incontinence, the patient has the anatomic and functional capacity for bowel control, but soils anyway.
Overflow incontinence is seen in conjunction with constipation, and is characterised by liquid faeces running around a large hard stool in the rectum, resulting in soiling.
Constipation and faecal incontinence is a common set of concerns that causes severe distress for children and their families.
DR ROB’S APPROACH
Dr Rob is a specialist in the identification and management of surgical disorders that may cause constipation and/or faecal incontinence. He developed a passion for Paediatric Colorectal Surgery during his time on the Colorectal Pelvic Reconstructive Service (CPRS) at the Royal Children's Hospital, and built on his specialist experience during his Urology and Colorectal surgery fellowship at the Bristol Royal Hospital for Children. He is dual trained in the care of bladder and bowel dysfunction and is highly motivated to work with children and their families to optimise their continence and quality of life.
Dr Rob will offer you a longer appointment to carefully go through the history of your childs symptoms. Dr Rob will ask to examine your child, but there will be no painful or invasive examinations performed during your meeting with him. If you have any previous investigations, such as X-rays or a colonoscopy, it is best if you have the reports forwarded to Dr Rob’s team in advance. If you have the time, it is recommended to complete a bladder and bowel diary prior to your appointment, but if you do not have time there is still plenty that can be achieved during the appointment.
For many patients, surgery is not required. If there is a possibility of an underlying surgical disorder, Dr Rob may arrange more tests such as MRI, or may recommend a general anaesthetic so that he can carefully examine your child while they are asleep, and perform any other necessary tests.
The most common extra test is a biopsy of the inside of the rectum, to check for Hirschprungs disease. This is performed as a day case procedure, your child will recover rapidly, and the results will be available 1 week later.
DR ROB McCUSKER
Gold Coast Children’s Surgeon
Dr Rob is dedicated to the highest quality of care and technical excellence for his patients.