Aanpak van fecale incontinentie op basis van een organisch onderliggend lijden

Faecal incontinence is a frequently seen problem in children. Pediatric faecal incontinence can be divided in 5 categories, 2 functional (95% of cases) and 3 organic reasons (5% of cases): (1) functional faecal retention with overflow diarrea, (2) functional nonretentive faecal encopresis, (3) spinal lesions (congenital or acquired), (4) children with anorectal malformations, (5) anal dysfunction. Spina bifida (SB) is a congenital disorder with a variable degree of incomplete closure of the spine. Bowel problems are constipation and faecal incontinence and can be seen in 85% of SB patients. A systematic, stepwise approach is used in these patients, leading to pseudo-continence of 60 to 80%. The first step is the aggressive treatment of constipation since birth. From 4 to 5 years of age treatment to achieve continence can be started. Toilet sitting, physiotherapy and anal stimulation can be tried. Manual evacuation is used in SB patients with hard stools. If these techniques fail, colonic washouts can be tried. Large volume colonic washouts can be given retrograde (via anus) or antegrade (via stoma). Anorectal malformations are birth defects with a prevalence of 1/2500-5000 neonates. Associated bowel problems vary according to the type of defect, there are high (faecal incontinence up to 80%) and there are low forms (little faecal incontinence) of defects. Especially the anatomical disorder in relation to the musculus Levator ani is an important factor in achieving faecal continence. Posterior sagittal anorectoplasty (PSARP) is the currently most used surgery for correction of anorectal malformations. Regular follow up of anal scar and the presence of constipation is mandatory. Anal manometry can guide which patients can be helped with conventional treatments and which will need large volume colonic washouts. Hirschsprung disease is the most frequent cause of low obstruction in neonates. Rectal washouts are started before surgery. Treatment is surgical removal of the aganglionic bowel. Up to 90% achieves faecal continence, but even after surgery obstruction and constipation remains an important problem. A hypertonic anal sphincter is one of the main complications and can require laxatives, botox injections or even myectomy associated with large colon washouts in order to avoid recurrent enterocolitis. In organic causes of faecal incontinence, treatment of constipation is the first step and secondly the use of large volume colonic washouts in children who will not achieve spontaneous faecal continence