Al-Beltagi M. Clinical guidelines for the diagnosis and management of pediatric fecal incontinence: A comprehensive review and treatment algorithm. World J Clin Pediatr 2026; 15(4): 120203 [DOI: 10.5409/wjcp.120203]
Corresponding Author of This Article
Mohammed Al-Beltagi, MD, PhD, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, 1 Hassan Radwan Street, Tanta 31511, Algharbia, Egypt. mbelrem@hotmail.com
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Pediatrics
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review-article
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Al-Beltagi M. Clinical guidelines for the diagnosis and management of pediatric fecal incontinence: A comprehensive review and treatment algorithm. World J Clin Pediatr 2026; 15(4): 120203 [DOI: 10.5409/wjcp.120203]
World J Clin Pediatr. Dec 9, 2026; 15(4): 120203 Published online Dec 9, 2026. doi: 10.5409/wjcp.120203
Clinical guidelines for the diagnosis and management of pediatric fecal incontinence: A comprehensive review and treatment algorithm
Mohammed Al-Beltagi
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
Mohammed Al-Beltagi, Department of Pediatric, University Hospital, Arabian Gulf University, Manama 26671, Manama, Bahrain
Author contributions: Al-Beltagi M is the sole author of this article; Al-Beltagi M was responsible for conceptualizing and designing the review, conducting an extensive literature search and data acquisition, performing the analysis and interpretation of the integrated biological models, and drafting the manuscript; Al-Beltagi M critically revised the work for intellectual content, designed the clinical algorithms and tables, and provided final approval for publication.
AI contribution statement: No AI writing tools (such as ChatGPT, DeepL, or similar platforms) were used in the preparation of our manuscript. The manuscript was written entirely by the authors. The only tool used during the writing process was Grammarly, which is integrated into Microsoft Office, and was utilized solely for basic grammar correction and minor language refinement. It did not contribute to content generation, data analysis, or scientific writing.
Conflict-of-interest statement: Professor Mohammed Al-Beltagi, declares that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. No external funding was received for the preparation of this review, and the author has no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.
Corresponding author: Mohammed Al-Beltagi, MD, PhD, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, 1 Hassan Radwan Street, Tanta 31511, Algharbia, Egypt. mbelrem@hotmail.com
Received: February 24, 2026 Revised: April 8, 2026 Accepted: May 11, 2026 Published online: December 9, 2026 Processing time: 214 Days and 17.6 Hours
Abstract
Pediatric fecal incontinence (FI) is a multifactorial condition with functional, neurodevelopmental, and organic etiologies. Despite its prevalence, FI remains underdiagnosed, stigmatized, and associated with significant psychosocial and family burden. This review synthesizes current evidence on the diagnosis, pathophysiology, and management of pediatric FI and proposes practical, algorithm-based guidance for frontline clinicians and subspecialists. A structured literature search of PubMed, Scopus, and Cochrane databases was conducted, focusing on pediatric FI, functional and organic subtypes, neurodevelopmental comorbidities, and multidisciplinary interventions. Emphasis was placed on evidence-based management strategies, emerging therapeutic innovations, and psychosocial considerations. Functional retentive FI often responds to structured disimpaction, maintenance laxatives, and behavioral interventions, whereas non-retentive forms require tailored psychological and behavioral therapies. Organic etiologies often require long-term, multidisciplinary care, surgical intervention, or neuromodulation. Special populations—including children with autism spectrum disorder, attention-deficit/hyperactivity disorder, developmental delay, and postoperative anorectal conditions—require individualized, developmentally adapted programs. Psychosocial impacts on children and families are significant and require coordinated counseling. Emerging research highlights the gut-brain axis, microbiome modulation, digital behavioral applications, and precision bowel management as future directions. Limitations include heterogeneous study designs, lack of long-term pediatric randomized controlled trials, and variable outcome measures. Pediatric FI is a complex condition requiring early recognition, subtype-specific management, and multidisciplinary care. Algorithm-based, individualized strategies that integrate physiological, behavioral, and psychosocial components optimize long-term continence, psychosocial well-being, and quality of life. Future research should focus on standardized outcomes, neuromodulatory interventions, and precision, technology-enhanced therapies.
Core Tip: Pediatric fecal incontinence is a multifactorial disorder with functional, neurodevelopmental, and organic causes. Early recognition, accurate subtype differentiation, and structured, individualized bowel programs are essential for optimal outcomes. Functional retentive forms respond to disimpaction, maintenance laxatives, and behavioral strategies, whereas non-retentive and neurodevelopmentally complex cases require psychological interventions and caregiver-guided routines. Organic etiologies often require long-term, multidisciplinary care, surgical intervention, or neuromodulation. Psychosocial burden on children and families is significant and must be addressed. Emerging approaches—including gut-brain axis modulation, microbiome-targeted therapies, and digital behavioral platforms—promise precision, personalized care, and improved long-term quality of life.
