Children with fecal incontinence due to long-term constipation: What to do?

Children's stools are often caused by prolonged constipation in children. When stools are too large to be trapped in the lower bowel, softer, looser stools can leak from the anus and contaminate underwear. In most cases, this happens involuntarily, meaning the child does not intentionally dirty his pants.
If the child has frequent stools, one or more times a day, the parents need to find a way to treat the child.
In addition, fecal incontinence can also be caused by a number of other reasons such as:
Children need more toilet training. Children may have a "fear of the toilet". Irritable bowel syndrome . It is very rare for children to have fecal incontinence due to birth defects.

If the child is unable to have a bowel movement for 3 or 4 consecutive days, parents should take the child to see the doctor to have the stool removed in the child's lower intestine by enema or rectal medicine. Your doctor may also prescribe high doses of laxatives to help your child pass stools on their own.

The first step in treating constipation in children is to empty the colon. Measures applied usually include:
Enema : Pumping water into the rectum to create a urge to defecate. Suppositories: Increase intestinal stimulation to push stool out. Laxative: Helps cleanse the large intestine and rectum. Manual removal of stool: Sometimes pediatricians must use hands to help children remove large and hard stools that cannot be passed.

To make stools softer and easier to pass, the doctor can give your child one of the following drugs:
Dietary fiber supplements, bulk-forming: Increases absorption of water from the intestines, softens stools, and induces peristalsis normal bowel to pass stool. For example: the drug Methylcellulose; Stool softener group: Helps water penetrate the stool mass, making stool soft and easy to pass out without straining. Examples are Liquid Paraffin, Docusate ; Osmotic laxative group: Helps reduce water absorption in the intestinal wall, increases the amount of water in the intestinal lumen, softens stool and makes it easier to expel. Examples are Lactulose, Sorbitol, Macrogol, Polyethylene glycol, Glycerin. Children need to take these medicines as prescribed by the doctor to prevent stool obstruction. Usually, after taking the medicine, the child's intestines will regain the ability to contract and can easily pass stool.

In case the anti-constipation drugs listed above do not work, the doctor can give the child a laxative stimulant, such as Bisacodyl, which increases spasms in the colon and pushes stool toward the rectum. However, this group of drugs has some side effects such as abdominal cramps, diarrhea, nausea, and bloating, so it is necessary to strictly follow the instructions of the doctor.

If constipation in children persists, it is necessary to improve care to treat the root of the disease or prevent the disease from recurring. Parents can refer to some ways to take care of their children as follows:

To limit constipation that causes fecal incontinence, encourage children to eat more vegetables or foods rich in fiber. At the same time, limit dairy products such as: Fresh milk, yogurt, ice cream, cheese and cooked carrots. At mealtimes also avoid forcing your child to overeat, instead offer a few food choices so that the child can decide for himself.

Children need to sit on the toilet until they are able to have a bowel movement or at least every 10 minutes until they have a large bowel movement. Without such exercise, the drug will not be effective.
Usually, the child can clearly perceive the feeling of fullness of the rectum and the urge to defecate. However, if a child has a bowel obstruction for a long time, it is easy to lose this feeling and it takes 2-4 weeks to recover. During that time, children have to practice sitting on the toilet even if they don't feel like pooping. The best time to potty train your child is about 20-30 minutes after a meal.

Parents should patiently explain to children that stools will not come out on their own, children need to push when they have a bowel movement. In addition, teach your baby how to sit properly to defecate to ease the anal opening, such as sitting forward folded, chest touching thighs, leaning slightly forward and then relaxing will help stools easily move down.
If the child's feet cannot touch the floor, parents should add a small chair so that the child can rest and defecate comfortably.

If the child takes the medicine exactly as prescribed by the doctor and has regular bowel movements, the condition of fecal incontinence will not occur. However, getting the right medication and dose adjusted can take several weeks. During this time, some children are prone to relapse (usually after 4.5 days of not having a bowel movement).
Things parents need to do when a child has fecal incontinence :
Do not ignore fecal incontinence: As soon as a child has a leaky stool (a strange smell or unusual behavior), parents should remind the child to wash up. and change your pants immediately. Encourage children to find the teacher before the problem is discovered by others. Carrying out washing, it is best to let the child learn to do the cleaning independently. After cleaning, let the child sit in a basin of warm water for 5 minutes to relax the anal muscles and create a feeling of bowel movement. Then remind your child to sit on the toilet until he has a large bowel movement, or at least sit for 10 minutes every hour until he is able to have a bowel movement. Explain to the child that the cause of leaky stools is that the rectum is too full and needs to be emptied. Washing dirty pants: Older children can be guided by their parents on how to rinse the dirty pants in the toilet and then soak the pants with detergent (soap, washing powder) in a small basin. With children under 7-8 years old, it is likely that adults will have to do most of the work on their own. Do not blame the child: Do not scold, criticize or punish the child because this is not a deliberate fault of the child. Also, don't allow siblings or peers to tease your baby. In addition, parents should take their children to the doctor if they see cases where the child continues to have pain when having a bowel movement, recurrent stool obstruction, when the child refuses to take medicine or refuses to have a bowel movement... Doctors Pediatricians with knowledge and practical experience will be able to support families in more complex cases.
Besides, it is possible to add necessary micronutrients such as: Zinc, selenium, Chromium, Vitamins B1 and B6, Ginger, acerola fruit extract (vitamin C),... for babies to improve taste. , eat well, reach the correct height and weight, and exceed the standard, have a good immune system, strengthen the resistance to get sick less often and have less digestive problems.
For more nutritional knowledge and child care for each age, parents should regularly visit the website vimec.com and make an appointment with the leading doctors, pediatric and nutrition experts of the National General Hospital. Vinmec when needing advice on children's health.