Children presenting to the Pediatric Colorectal Bowel Management clinic with soiling after surgical repair of anorectal malformations or Hirschsprung can be categorized into two groups: Most are constipated and managed with laxatives and/or enemas, whereas the second subset has frequent loose stools. This second group, children with multiple loose stools, presents a unique challenge for the achievement of social bowel continence. We present three case studies illustrating various clinical presentations of incontinence with loose stools, along with dietary and pharmacologic management strategies and a treatment algorithm. Children who soil with loose stools can achieve social continence using a combination approach using toileting supports, diet manipulation, fiber supplementation, medications, and small-volume enemas.
Jennifer Kreiss, MN, PCPNP-BC Seattle Children's Hospital, Seattle, WA.
Monica Holder, RN, BSN, CPN The Colorectal Center for Children, Cincinnati Children's Hospital, Cincinnati, OH.
Patricia Kern, RN, BSN, CPN The Colorectal Center for Children, Cincinnati Children's Hospital, Cincinnati, OH.
Kristina Kneis, RD The Colorectal Center for Children, Cincinnati Children's Hospital, Cincinnati, OH.
The authors have declared no conflict of interest.
Correspondence: Jennifer Kreiss, MN, PCPNP-BC, Seattle Children's Hospital Reconstructive Pelvic Medicine, Seattle, WA. E-mail: firstname.lastname@example.org