Abstract
Fecal incontinence is a common childhood condition that causes significant disruption and impairment to children and families. Recent reviews have found that the treatment literature remains disjointed and difficult to interpret. Fecal incontinence should be conceptualized within a biopsychosocial model and treatment often occurs within some collaborative practice models with medical providers. We conducted an informal survey of pediatric psychologists nationwide who specialize in this issue to gather information about their clinical practice. A medical–behavioral approach to treatment is well supported and includes clean-out and maintenance treatment of constipation, education to the child and family about the condition, and behavioral interventions focused on improvements in toileting. Specific behavioral components supported by recent reviews and our survey of providers includes incentive programs based on operant conditioning and enhanced toilet training as successful treatments beyond what may be considered medical management. However, many other behavioral treatment components have been studied in small sample designs and case studies and are used clinically. The goal of this article is to present clinical application of evidence-based treatment strategies in the treatment of fecal incontinence. We present our clinical approach using treatment algorithms for basic management and advanced behavioral treatments for this clinical issue. The treatment of fecal incontinence can occur in diverse practice settings with collaboration with medical providers and implementation of evidence-based behavioral treatments.
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