title: Management of functional nonretentive fecal incontinence in children: Recommendations from the International Children's Continence Society.
abstract: BACKGROUND
  Fecal incontinence (FI) in children is frequently encountered in pediatric practice, and often occurs in combination with urinary incontinence. In most cases, FI is constipation-associated, but in 20% of children presenting with FI, no constipation or other underlying cause can be found - these children suffer from functional nonretentive fecal incontinence (FNRFI).
  
  
  OBJECTIVE
  To summarize the evidence-based recommendations of the International Children's Continence Society for the evaluation and management of children with FNRFI.
  
  
  CONCLUSIONS
  Functional nonretentive fecal incontinence is a clinical diagnosis based on medical history and physical examination. Except for determining colonic transit time, additional investigations are seldom indicated in the workup of FNRFI. Treatment should consist of education, a nonaccusatory approach, and a toileting program encompassing a daily bowel diary and a reward system. Special attention should be paid to psychosocial or behavioral problems, since these frequently occur in affected children. Functional nonretentive fecal incontinence is often difficult to treat, requiring prolonged therapies with incremental improvement on treatment and frequent relapses.
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands. Electronic address: i.j.koppen@amc.nl.
authors.forename: I J N
authors.initials: IJ
authors.lastname: Koppen
authors.affiliation: Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: von Gontard
authors.affiliation: Paediatric Gastroenterology Victoria, Royal Children's Hospital, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Chase
authors.affiliation: Division of Pediatric Urology, University of Iowa, Iowa City, United States of America.
authors.forename: C S
authors.initials: CS
authors.lastname: Cooper
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: C S
authors.initials: CS
authors.lastname: Rittig
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, United States of America.
authors.forename: S B
authors.initials: SB
authors.lastname: Bauer
authors.affiliation: Children's Urology Group, All Children's Hospital/Johns Hopkins Medicine, University of South Florida, Tampa, FL, United States of America.
authors.forename: Y
authors.initials: Y
authors.lastname: Homsy
authors.affiliation: Taipei Tzu Chi Hospital, Buddhist Medical Foundation, New Taipei, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
authors.forename: S S
authors.initials: SS
authors.lastname: Yang
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D002648:Child; D019468:Disease Management; D005242:Fecal Incontinence / Q000628:therapy*; D006801:Humans; D007391:International Cooperation; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D012955:Societies, Medical
keywords: Encopresis; Fecal incontinence; Nonretentive; Soiling