概述

儿童大便失禁,又称为漏粪,是指(通常不自觉地)反复排便在裤子上。通常发生在结肠和直肠堆满粪便时;结肠过度充盈,液体粪便会从滞留的大便周围漏出并沾污内裤。滞留的大便最终会令肠道肿胀(扩张),导致儿童丧失对肠道运动的控制能力。

儿童大便失禁通常在 4 岁后发生,此时儿童已学会如厕。大部分病例的漏粪都是慢性便秘的症状。没有便秘、只是由情绪问题引起的情况较为少见。

儿童大便失禁会令父母沮丧,让孩子尴尬。但是,只要耐心对待和给予正面强化,儿童大便失禁的治疗通常都较为成功。

症状

儿童大便失禁的体征和症状可能包括:

  • 内裤上漏有大便或液体便,可能误认为是腹泻
  • 便秘伴大便干硬
  • 排出块头大到堵塞或几乎堵塞马桶的大便
  • 避免排便行为
  • 排便间隔时间长
  • 食欲不振
  • 腹痛
  • 白天尿裤子或尿床问题(遗尿症)
  • 反复性膀胱感染,多见于女孩

何时就医

如果您的孩子已经接受过如厕训练,并且开始出现一种或多种上述症状,请联系医生。

When to see a doctor

Call your doctor if your child is already toilet trained and starts experiencing one or more of the symptoms listed above.

病因

儿童大便失禁可能有若干种原因,包括便秘和情绪问题。

便秘

大多数儿童大便失禁病例都是慢性便秘所致。便秘时,孩子的大便可能又硬又干,而且排便时还可能伴有疼痛。这会导致孩子不愿意去厕所,进而导致问题变得更加严重。

大便在结肠内停留的时间越长,孩子就越难将大便排出。结肠会伸展,最终累及发出如厕信号的神经。如果结肠变得太满,软便或稀液状大便可能会从滞留的大便周围漏出,还可能会导致无法控制排便。

导致便秘的一些原因包括:

  • 因为害怕排便(尤其是外出时)或排便疼痛而憋住大便。
  • 不想中断玩耍或其他活动
  • 膳食纤维摄入太少
  • 饮用的液体不足
  • 饮用太多牛奶或对牛奶不耐受(这种情况较为罕见),不过研究结果在这些问题上存有争议

情绪问题

情绪紧张可能引发儿童大便失禁。儿童可能承受以下压力:

  • 排便训练过早、排便困难或有抵触情绪
  • 孩子的生活发生变化,例如饮食改变、排便训练、开始上学或时间安排改变
  • 情绪压力来源,例如父母离婚或有兄弟姐妹出生

Constipation

Most cases of encopresis are the result of chronic constipation. In constipation, the child's stool is hard, dry and may be painful to pass. As a result, the child avoids going to the toilet — making the problem worse.

The longer the stool remains in the colon, the more difficult it is for the child to push stool out. The colon stretches, ultimately affecting the nerves that signal when it's time to go to the toilet. When the colon becomes too full, soft or liquid stool may leak out around the retained stool or loss of control over bowel movements may occur.

Some causes of constipation include:

  • Withholding stool due to fear of using the toilet (especially when away from home) or because passing stool is painful
  • Not wanting to interrupt play or other activities
  • Eating too little fiber
  • Not drinking enough fluids
  • Drinking too much cow's milk or, rarely, an intolerance to cow's milk — though research results conflict on these issues

Emotional issues

Emotional stress may trigger encopresis. A child may experience stress from:

  • Premature, difficult or conflict-filled toilet training
  • Changes in the child's life, such as dietary changes, toilet training, starting school or schedule changes
  • Emotional stressors, for example, the divorce of a parent or the birth of a sibling

风险因素

儿童大便失禁在男孩中更为常见。以下风险因素可能会增加发生儿童大便失禁的几率:

  • 使用可能引起便秘的药物,例如止咳药
  • 注意缺陷多动障碍(ADHD)
  • 自闭症谱系障碍
  • 焦虑或抑郁症

并发症

大便失禁患儿可能会经历各种情绪,包括尴尬、沮丧、羞耻和愤怒。如果您的孩子被朋友取笑,或受到成年人的批评或惩罚,则可能会感到沮丧或自卑。

预防

以下是一些有助于预防儿童大便失禁及其并发症的策略。

避免便秘

通过提供富含纤维的均衡饮食并鼓励孩子多喝水,来帮助孩子避免便秘。

了解有效的排便训练技巧

自行学习有效的排便训练技巧。避免过早开始或急于求成。等到您的孩子做好准备之后,再使用正面的强化和鼓励帮助他们取得进步。向医生咨询有关排便训练的资源。

及早治疗儿童大便失禁

早期治疗(包括您孩子的医生或心理健康专家提供的指导)可以帮助预防儿童大便失禁带来的社会和情感影响。定期接受医生随访有助于发现持续或反复出现的问题,以便根据需要调整治疗方法。

Avoid constipation

Help your child avoid constipation by providing a balanced diet that's high in fiber and encouraging your child to drink enough water.

Learn about effective toilet training techniques

Educate yourself on effective toilet training techniques. Avoid starting too early or being too forceful in your methods. Wait until your child is ready, and then use positive reinforcement and encouragement to help make progress. Ask your doctor about resources on toilet training.

Get early treatment for encopresis

Early treatment, including guidance from your child's doctor or mental health professional, can help prevent the social and emotional impact of encopresis. Regular follow-up visits with your doctor can help identify ongoing or recurring problems so that adjustments in treatment can be made as needed.

Sept. 25, 2021
  1. Kliegman RM. Motility disorders and Hirschsprung's disease. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Aug. 17, 2021.
  2. AskMayoExpert. Encopresis. Mayo Clinic; 2019.
  3. Bowel control problems (fecal incontinence). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence. Accessed Aug. 13, 2021.
  4. Fecal incontinence in children. International Foundation for Functional Gastrointestinal Disorders. https://aboutincontinence.org/what-is-incontinence/fecal-incontinence-in-children/. Accessed Aug. 17, 2021.
  5. Kellerman RD, et al. Encopresis. In: Conn's Current Therapy 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed Aug. 17, 2021.
  6. Sood MR. Functional fecal incontinence in infants and children: Definition, clinical manifestations, and evaluation. https://www.uptodate.com/contents/search. Accessed Aug. 17, 2021.

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儿童大便失禁