Constipation and faecal incontinence

Overview & Definition

A toddler who screams and clenches on the potty, a preschooler who stains their underwear several times a day, and a school-aged child who has not opened their bowels for a week and now has a palpable abdominal mass are all showing the same condition from different angles. Constipation in childhood is common, distressing, and in the great majority of children has no underlying disease. Most of these children have functional constipation, a positive Rome IV diagnosis rather than a label of exclusion. [1]

Constipation means infrequent or painful passage of hard stool, and the child may also have large-diameter stools, withholding behaviour, and a palpable rectal or abdominal faecal mass. Faecal incontinence is the involuntary passage of stool in a child old enough to be toilet trained, usually beyond four years of age. In most children the two problems are linked, because retained stool overflows around a rectal impaction, but a minority soil without any constipation at all. [2]

The core clinical skill is to make a confident functional diagnosis, treat early and adequately, and stay alert for the small number of children whose constipation signals organic disease such as Hirschsprung disease. Early, effective treatment matters because an established withholding cycle with a stretched rectum is far harder to reverse than a new problem. Families need to understand from the outset that treatment is measured in months, not days. [1]

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10. [10]Koppen IJN, Vriesman MH, Saps M, Rajindrajith S, Shi X, van Etten-Jamaludin FS, Di Lorenzo C, Benninga MA, Tabbers MM Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis. J Pediatr, 2018.PMID 29656863
11. [11]Rajindrajith S, Hathagoda W, Devanarayana NM, Benninga M Non-retentive fecal incontinence in children: current perspectives and future directions. Expert Rev Gastroenterol Hepatol, 2026.PMID 42090001