Fecal Incontinence
Everything in the library about fecal incontinence — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Fundamentals
2 items
Fecal Incontinence Bowel Management: Pediatric Bowel Management 2013
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During the Pediatric Bowel Management Course in 2013,directors DrsAndrea Bischoff, Alberto Peña and Todd Ponsky discusscontroversial/hot topics surrounding the management and diagnosis of pediatric bowel conditions.In this session, Dr. Andr
video85:01 · Jan 2019
Anorectal Malformations: Introduction and Overview for bowel management
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Join our symposia directors Andrea Bischoff, Alberto Peña and Todd Ponsky for this live video webcast and global discussion covering a wide range of topics related to diagnosis and management of fecal incontinence, constipation and stoma ma
video26:08 · Jan 2019
Surgical Management
2 items
Sphincter Reconstruction for Patients with Soiling after a Pull-Through for Hirschsprung Disease
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Sphincter reconstruction technique is described in detail for patients with soiling due to an iatrogenic overstretching of the anal sphincters at the time of the initial pull-through procedure for Hirschsprung disease. Until this technique,
video5:04 · Oct 2022
Colorectal Surgery: What does the anesthesia provider need to know?
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Children's National Medical Center, Anesthesiology Grand Rounds Part 2 - August 31, 2023
Marc Levitt, MD
video24:52 · Oct 2023
Evidence & Research
2 items
Colorectal Quiz Episode 37: The Yancey-Soave story of the original surgical descriptions for Hirschsprung disease
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Swenson described the first operation for Hirschsprung disease in the 1940s, which involved a full thickness rectal dissection. To respond to complications related to the dissection adjacent to the rectal wall, several surgeons came up with
podcast20:08 · Apr 2023
The Colorectal Quiz Episode 21: The History of Hirschsprung Disease
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The treatment for Hirschsprung disease has undergone tremendous evolution over the past century. Here, Dr. Marc Levitt and Dr. Jason Frischer discuss the histor
podcast15:56 · Jul 2026
Case-Based Learning
1 item
Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene
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Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital
video5:47 · Mar 2026
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene
Patient was previously healthy but at age 3 suffered from Fournier's gangrene complicated by extensive sphincter and perineal muscle injury
clinical0:00 ↗
Initial management consisted of successive surgical debridements and creation of a diverting colostomy
clinical0:15 ↗
Patient healed but was left with a patulous anus and no dentate line and presumed to be fecally incontinent because of scarring
clinical0:22 ↗
Initial electrical stimulation showed very minimal sphincteric contractions
clinical0:35 ↗
Patient had a skin level anal stricture
clinical0:51 ↗
In the deeper layers, excellent muscle contraction was observed
clinical1:47 ↗
The muscle complex consists of parasagittal fibers and the levators
clinical1:56 ↗
The surgical technique is analogous to the conclusion of a PSARP for an anorectal malformation, tacking the muscle complex to the rectum
clinical2:15 ↗
When the reconstructed muscles contract, the rectum will be pulled in and closed
clinical2:25 ↗
It is very important that the muscle-tacking sutures not narrow the rectal lumen
clinical2:32 ↗
After reconstruction, the anoplasty is no longer patulous because the muscles are now holding it in
clinical3:48 ↗
Post-reconstruction electrical stimulation demonstrated the anus being closed by the sphincteric muscles
clinical5:03 ↗
Patient went on to have their colostomy closed and now has bowel control
clinical5:42 ↗
Colorectal Surgery: What does the anesthesia provider need to know?
Associated malformations in colorectal patients affect airway and cardiac systems, relevant to anesthesia choices
clinicalMark1:05 ↗
Electrical stimulation is used to identify the ideal sphincteric ellipse for anus placement
clinicalMark1:36 ↗
Neuromuscular blockade prevents visualization of muscle contractions during sphincter mapping
clinicalMark1:47 ↗
Neuromuscular blockade should be avoided at the beginning of cases requiring sphincter mapping
guidelineMark1:58 ↗
Neuromuscular blockade can be administered after sphincter marking is complete
guidelineMark2:16 ↗
Patients with existing anus (Hirschsprung's, fecal incontinence with Malone) do not require sphincter mapping, so neuromuscular blockade is acceptable
clinicalMark2:52 ↗
Prone position provides better access to the pelvis for colorectal surgery
clinicalMark3:23 ↗
Alberto Pena introduced the posterior sagittal approach to the rectum in 1980
clinicalMark3:31 ↗
Prone positioning allows three surgeons to visualize the field well, compared to one in supine perineal approach
clinicalMark4:23 ↗
Lower extremity IV access is acceptable with sterile tubing across the drape
guidelineMark4:59 ↗
Baseline hematocrit is important for long cases to monitor for blood loss
clinicalMark5:24 ↗
Transfusion is rare in colorectal cases, occurring approximately once or twice per year
epidemiologicalMark5:34 ↗
Hyperviscosity should be avoided because reconstructed tissues are based on single blood vessels
clinicalMark5:45 ↗
Some colorectal reconstructions are analogous to free flap cases, with tissue moved based on a single vessel
clinicalMark6:13 ↗
Bowel prep causes dehydration requiring fluid catch-up
clinicalMark6:38 ↗
When the bladder is open during surgery, urine output cannot be monitored for approximately 6 hours
clinicalMark6:50 ↗
Cloaca repair can range from 3 to 8 hours depending on complexity
clinicalMark7:21 ↗
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