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Achieving Social Bowel Continence in Children With Hypermotility After Repair of Anorectal Malformations and Hirschsprung

Abstract 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.