For a child with imperforate anus or anorectal malformation, the immediate goals of surgery are to enable the body to pass waste safely and reduce the risk of infection. In some cases, a single reconstructive surgery can help restore a way for the body to pass waste; however, most complex malformations will require a series of surgeries, performed over several months, to help normalize bowel function.
Experts at Nationwide Children’s create personalized surgical plans for each child that addresses specific malformations, future growth considerations and any other health conditions. Depending on the severity of the condition, surgeries can be done within the first few days or weeks of a baby’s life, or can be delayed for several months if necessary.
Any child who goes through a malformation repair is given a detailed post-surgery recovery plan that helps them heal properly and increases their likelihood of regaining healthy bowel function and long-term bowel control.
Colostomy: When health conditions prevent a surgeon from immediately repairing an anal malformation, a colostomy may be used to temporarily divert waste into bags attached to the abdomen (stomach area). This procedure allows the baby to have normal digestion and growth, and reduces the risk of infection while they wait for the next surgery.
Reconstructive surgery: The goal of reconstructive surgery is to create a normal connection between the rectum (the very end of the large intestine) and the anal opening, and close off any fistulas (abnormal openings) that prevent healthy bowel movements. If an anal opening is missing, then the surgeon will create a new one. This step usually requires a hospital stay of two to four days. Two common procedures are:
Post-surgical recovery with colostomy: After the reconstructive surgery, typically the colostomy will stay in place for six to eight weeks so the rectum and anal opening can heal completely before it comes in contact with any waste. During this healing period, caregivers will perform anal dilations, which slowly stretch the anus to the correct size for the child’s age so that stool can be comfortably passed. Clinic staff will help train caregivers on how to use anal dilators, which will usually be used over a period of six months, even after the colostomy is removed.
Colostomy closure: after the anus has reached the desired size, the colostomy can be closed. The two ends of the bowel aer sewn together. Feedings begin after several days once the intestines have healed and the child passes stool and gas through the previously created rectum and anus.
After colostomy removal: Several days after the colostomy is removed, your baby will begin passing stools through their anus. At first, stools are usually loose and frequent. Diaper rash and skin irritation can occur, and clinic staff can help advise you on safe topical treatments to help protect your child’s skin. Within a few weeks though, stools will become firmer and less frequent. Anal dilatations are continued for several more months.
Post-surgery recovery plans are designed to help your child heal and set the stage for successful, long term bowel control. These plans can cover several aspects of your child’s health including diet, anal dilations, wound care, and potty training. It may feel overwhelming at times, but your healthcare team is there to answer your questions and help you each step of the way.
Avoiding post-surgery complications and improving potty training goals
One of the best ways to ensure good healing after reconstructive surgery is to help your child avoid constipation, which can be particularly difficult in infants and toddlers. The combination of the right diet, laxatives, and fiber is very helpful, and should be maintained up until the age of potty training.
By avoiding constipation, your child can begin to learn a good bowel movement pattern – roughly two well-formed bowel movements a day. When a child understands what a normal bowel movement feels like and approximate frequency, potty training tends to be easier.
While surgeries can help repair the parts of the body needed to pass solid waste, it cannot always restore the nerves and muscles the body relies on to tell a child when it’s time to go to the bathroom, and to hold in stool. In cases where there are missing or damaged nerves or muscles, severe constipation or difficulties with potty training, a bowel management program may be needed.