Loening-Baucke V
The University of Iowa, Iowa City, USA.
Clin Pediatr (Phila). 2000 Oct;39(10):603-7. doi: 10.1177/000992280003901005.
Fecal soiling is common in childhood and can be caused by stool toileting refusal, fecal incontinence due to organic disease, or encopresis due to functional constipation. Anatomical, neurologic, and inflammatory causes for fecal soiling are ruled out by history and physical examination and, if necessary, by anorectal manometry, barium enema, and rectal biopsy. The initial treatment suggestion for children with stool toileting refusal is to put the child back into pull-ups or diapers. Most children with fecal soiling due to organic disease continue with some degree of incontinence despite optimal medical management. Antegrade enema administration helps those with severe fecal incontinence due to organic causes who do not respond to medical management. Successful treatment of constipation and encopresis requires a combination of medical therapy, nutritional intervention, behavioral intervention, and long-term compliance with laxative use. The combined treatment approach improves the constipation and encopresis in all patients who comply with the treatment program. In some children, cow's milk protein intolerance may be the cause. In them, cow's milk protein needs to be eliminated.
大便失禁在儿童时期很常见，可能由拒绝坐便、器质性疾病导致的大便失禁或功能性便秘引起的遗粪症所致。通过病史和体格检查，必要时通过肛门直肠测压、钡灌肠和直肠活检排除大便失禁的解剖学、神经学和炎症性病因。对于拒绝坐便的儿童，初步治疗建议是让孩子重新穿上拉拉裤或尿布。大多数因器质性疾病导致大便失禁的儿童，尽管接受了最佳的药物治疗，仍会有一定程度的失禁。顺行灌肠有助于治疗那些因器质性病因导致严重大便失禁且对药物治疗无反应的儿童。成功治疗便秘和遗粪症需要药物治疗、营养干预、行为干预以及长期坚持使用泻药相结合。联合治疗方法可改善所有遵守治疗方案患者的便秘和遗粪症情况。在一些儿童中，牛奶蛋白不耐受可能是病因。对于他们，需要消除牛奶蛋白。
