Faecal soiling

Epidemiology

Pathophysiology

Clinical
presentation

Diagnosis

Management

Definition

Behavioural disorder of middle
childhood (>4y) with repeat passage
of stool in innapropriate setting

M>F

Middle childhood (>4y)

Complex, may be voluntary or not

Physcial factors
Constipation (with overflow)
Anal fissure pain

Psychosocial factors
Fear of punishment for incontinence
Anxiety about using toilet
Abuse (e.g. sexual)

Mechanism
Retention of faeces and hard faecal bolus in rectum
Dilation and habituation of rectum (child unaware when to empty)
Stool may seep out spontaneously

Soiling of underclothes

Examination
Abdo - faecal mass
PR - hard/soft faecal mass, any fissures
Developmental - any delay

History
Predisposing, precipitating, perpetuating factors
Social setup at home

Conservative
Information, advice, support
Dietary fibre intake
Encourage regular defaecation (star chart)
Psychiatric referral if conservative and medical not helping

Medical

Laxatives
Indication: retention
E.g. macrogol, senna
MOA: softeners, stimulants

Enemas
Indication: impaction