They were first seen by the family pediatrician in September and she was given a series of enemas that were completely unsuccessful in resolving this problem. She was also given a fecal colonic irrigation. It was completely unsuccessful [00:03:03] and there was nothing to suggest a structural problem with the bowel or any sort of obstruction.
I started by informing the mother that this was a case of fecal incontinence or soiling and that likely the child was having a problem emptying her bowels and that I had a spectrum of options for the family to consider.
I then advised her that she was in a city of approximately 10 million people and that there were at least four facilities that had substantial capacity for treating the child. One was the U.S. Department of Agriculture, one was the hospital down the street, one was across the river down the street, and one was several miles away in another city.
The father said that this was what the child always did and that they have tried everything to resolve the problem. They had tried enemas, he had tried drugs, they had tried celiac disease, they had tried surgery, they had tried counseling, they had tried dietary changes, they had tried topically applied ointments, and nothing worked. They had tried special diets, and nothing worked. And they did not want to try anything new because she has a younger sister they wanted to control the same way. d2c66b5586