Nonretentive fecal incontinence in children: current perspectives and future directions

INTRODUCTION: Non-retentive fecal incontinence (NRFI) is an uncommon condition. Those with NRFI often endure considerable social and emotional challenges - such as low self-esteem, embarrassment, and social isolation - that significantly impact their quality of life. AREA COVERED: A literature search conducted using PubMed, and other related databases using appropriate keywords. Relevant articles published in English language were identified and critically appraised to synthesis current evidence and major gaps in the knowledge. The review covers historical aspects of evolution of the diagnostic criteria, epidemiology, psychological impact, clinical evaluation, therapeutic modalities and future perspectives of NRFI. EXPERT OPINION: After two decades of research, understanding of NRFI remains substantially minimal. Although we understand the condition is prevailing and having devastated psychological consequences, the pathophysiology of NRFI is still not clear. The knowledge gap significantly affects the development of novel therapeutic options. Future research should focus on elucidating physiological alterations such as gastrointestinal functions and gut-brain interaction using sophisticated high-definition colonic and anorectal manometry and fMRI studies to push the field forward. While using the standard care package to help these children, it is essential to explore the value of biofeedback, pelvic floor physiotherapy and neuromodulation in collaborative trials to advance the treatment options.