ABSTRACT
The workup of patients with faecal incontinence includes a history and physical exam, sacral X-ray, water-soluble contrast enema and spinal MRI. A hypo developed sacrum correlates with weak sphincter muscles and impaired anal canal sensation. Barium enemas are not advised, as they can exacerbate constipation and form concretions, and water-soluble contrast is preferable. Patients with good risk factors are more likely to have bowel control, and behave like those with idiopathic constipation. Controlling their constipation will eliminate their soiling. Patients with a poor prognosis for bowel control have true incontinence and benefit from bowel management with a mechanical emptying of the colon with daily enemas. Patients likely to have good bowel control include patients with so-called 'low' anorectal malformations, those with a good sacrum and no tethered cord, nor other associated spinal problems. Patients likely to have faecal incontinence include those with so-called 'high' malformations, as well as those with poor sacrums, tethered cords, or other associated spinal anomalies.
