A Case of Functional Non-Retentive Fecal Incontinence Mimicking Organic Disease”

Functional Fecal Incontinence in an 11-Year-Old Boy

Abstract

Abstract

Background: 

Functional non-retentive fecal incontinence (FNRFI) is characterized by involuntary defecation occurring ≥1/week for ≥8 weeks in children >4 years, without constipation or fecal retention. It accounts for approximately 20% of pediatric fecal incontinence (FI) cases and is closely linked to behavioral and psychosocial factors.

Case Presentation:

An 11-year-old male presented with daily fecal soiling for four years. Neurological examination and spinal MRI were normal. Digital rectal examination revealed reduced sphincter tone without fecal impaction. Colonic transit time (48 hours) was normal, confirming FNRFI per Rome IV criteria. Management involved structured toilet training (post-meal and 4 PM), behavioral reinforcement, and dietary modification (avoiding excessive fiber).

Conclusion: 

Functional non-retentive fecal incontinence is a frequently misdiagnosed condition that can mimic organic and constipation-related disorders. This case emphasizes the importance of a structured diagnostic approach integrating clinical history, transit studies, and selective imaging. Early identification and behavioral management can lead to favorable outcomes while avoiding unnecessary treatments and investigations.”

Keywords: Fecal incontinence; Functional non-retentive; Children; Behavioral therapy; Rome IV criteria