Background: Fecal incontinence (FI) resembles a disastrous challenge for those who suffer from it. True faecal incontinence occurs when a patient's physical restrictions prevent them from having voluntary bowel movements, necessitating the use of an artificial mechanism to empty the colon. FI frequently makes it more difficult for children to fit in with society, resulting in serious psychological consequences. More children than previously believed are affected by this problem, including those who were born with anorectal malformations, Hirschsprung's disease (HD) and spinal cord disorders, or spinal injuries. Few post-operative complications have a greater impact on patient's quality of life. Objective: This article aimed to review true fecal incontinence and possible modalities of management in children. Methods: We searched Google Scholar, Science Direct, and other online databases for true faecal incontinence and management. The authors also reviewed references from pertinent literature, however only the most recent or comprehensive studies from January 2000 to February 2022 were included. Documents in languages other than English were disqualified due to lack of translation-related sources. Papers such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations that were not part of larger scientific studies were excluded. Conclusion: Following surgery for Hirschsprung disease, faecal incontinence may develop. Incontinence is persistent, severe, and most likely irreversible when the anal canal is injured. This issue might be prevented by maintaining the anal canal.