Functional Constipation and Fecal Incontinence

Constipation and fecal incontinence represent common problems in children. Beyond the neonatal period, only a minority of children have an organic cause for their constipation, and the etiology remains not well understood. Constipation rarely leads to life-threatening complications but can cause emotional and physical distress and concerns for children and their families, ultimately impairing health-related quality of life. The hallmarks of constipation are infrequent painful defecation and fecal incontinence often accompanied by abdominal pain. In less than 15% of cases, children have fecal incontinence without a history and physical examination that indicates underlying constipation. These latter children are classified as having functional nonretentive fecal incontinence (FNRFI) according to the Rome IV criteria. The aims of this chapter are to describe functional defecation disorders in children: functional constipation associated with or without fecal incontinence and FNRFI. The chapter will also describe diagnostic approaches and treatment regimens for this disorder and will report on treatment outcomes.