Children with loose stools have an overactive colon (hypermotility). Causes of hypermotility may include inflammatory bowel disease, infectious diarrheas and irritable bowel syndrome.
For these children, a constipating diet consisting of water-soluble fiber and/or medications to slow down the colon are used.
If the patient has a shortened colon related to a prior surgery (such as in patients with an anorectal malformation, Hirschsprung disease or ulcerative colitis), a daily small volume enema may also be required to help with soiling. To determine the right combination, treatment is initiated with enemas (only for those patients who are soiling), a very strict diet, medication and a water-soluble fiber. Most children respond to this aggressive management within one to two weeks.
Children should remain on a strict diet until they are able to remain clean for up to three days in a row. This diet includes three scheduled meals and no snacks. They can then choose one new food every two to three days, and the effect of this new food on the child’s colonic activity is observed. If the child soils after eating a newly introduced food, that food must be eliminated.
Over several months, maintaining a diet that includes as many foods as possible should be the goal. If the child remains clean with this diet, their medication can gradually be reduced to the lowest effective dose to keep the child from soiling.
Some children with hypermotility may develop a severe and painful buttock rash. To help treat the rash, the buttock should be covered with zinc oxide-based barriers, skin emollients and/or liquid skin protectants with each diaper change.