Pensabene Licia, Nurko Samuel
Department of Gastroenterology and Nutrition, Hunnewell Ground, 300 Longwood Avenue, Boston, MA 02115, USA.
Curr Treat Options Gastroenterol. 2004 Oct;7(5):381-390. doi: 10.1007/s11938-004-0051-z.
The management of the fecal incontinence in children is difficult, and its social consequences are usually devastating. The general objectives of any bowel program are to produce social continence, predictability, and eventually independence. How to achieve those goals depends in part on the underlying condition. In children, fecal incontinence can occur from a variety of conditions. The most common is overflow incontinence from functional fecal retention, but it can also occur in otherwise healthy children with functional nonretentive fecal soiling or in children with organic causes of fecal incontinence, such as congenital malformations, or any other condition affecting the anorectum, anal sphincters, or the spinal cord. The therapeutic regimen that is recommended in patients with nonretentive fecal soiling consists of explanation and support for the child and parents, a nonaccusatory approach, and a toilet training program with a rewarding system. Biofeedback does not play an important role, and laxatives need to be used with caution, as they may exacerbate the incontinence. For those patients with congenital/neuropathic incontinence a combination of maneuvers to change stool consistency, colonic transit, anorectal function, and rectosigmoid evacuation is used. Stool consistency can be changed with the use of dietary interventions or medications. Stool transit can be slowed (antimotility agents) or accelerated (laxatives) with the use of medications. Anorectal function can be improved with the use of biofeedback or procedures to alter sphincter pressure, and the production of a bowel movement can be induced with maneuvers to empty the sigmoid (suppositories, enemas). With the recent advent of the Antegrade Colonic Enema (ACE), the patient is then able to be predictable and independent. This procedure creates a continent conduit from the skin to the cecum that can be catheterized or accessed for self-administration of enemas. The ACE has revolutionized the treatment of children with fecal incontinence.
儿童大便失禁的管理很困难，其社会后果通常具有破坏性。任何排便计划的总体目标都是实现社交性控便、可预测性，并最终实现独立。如何实现这些目标部分取决于潜在病因。在儿童中，大便失禁可由多种情况引起。最常见的是功能性大便潴留导致的充溢性失禁，但也可能发生在其他方面健康但有功能性无潴留性大便污染的儿童，或有器质性大便失禁病因的儿童身上，如先天性畸形，或任何影响肛门直肠、肛门括约肌或脊髓的其他情况。对于无潴留性大便污染的患者，推荐的治疗方案包括对儿童及其父母的解释和支持、非指责性方法，以及带有奖励系统的排便训练计划。生物反馈不起重要作用，泻药需谨慎使用，因为它们可能会加重失禁。对于那些先天性/神经性失禁的患者，则采用一系列改变大便稠度、结肠传输、肛门直肠功能和直肠乙状结肠排空的方法。可通过饮食干预或药物改变大便稠度。可使用药物减缓（抗蠕动剂）或加速（泻药）大便传输。可通过生物反馈或改变括约肌压力的手术改善肛门直肠功能，还可通过排空乙状结肠的手法（栓剂、灌肠）诱导排便。随着最近顺行结肠灌肠（ACE）的出现，患者能够实现可预测性和独立性。该手术创建了一条从皮肤到盲肠的可控通道，可通过导管插入或自行进行灌肠。ACE彻底改变了儿童大便失禁的治疗方式。
