After the pull-through procedure and colostomy closure, many parents feel that the stress is now behind them. But they must realize that the new focus should then move to the treatment of constipation and urologic management. The bowels are ideally managed with diet, fiber, a Senna-based laxative, or in some cases, enemas at an early age. Urologic care at this point is vital to ensuring good renal health. There are a few things you should keep in mind as your child with ARM ages.
Contrary to popular belief, there is no evidence to suggest that patients with ARM should be small or have delayed growth. However, for children with ARM, growth curves must be carefully monitored. Constipation, bowel irritation, multiple surgeries, anatomic bowel problems and kidney and bladder issues can all impact growth and development. It is never too early for a nutritional evaluation.
The Center for Colorectal and Pelvic Reconstruction has devised a urologic monitoring plan for patients with ARM. Children with a cloacal malformation are somewhat different and will have a different testing plan. Your surgeon will be able to tell you the location of the fistula and the type of ARM your child has which guides the evaluation and correlates with the incidence of associated urologic issues.
Males with rectoperineal fistula or rectoprostatic fistula and females with rectoperineal fistula or rectovestibular fistula (with or without vaginal atresia) can expect the following urologic examinations:
Males with a rectobladder neck fistula can expect the following urologic monitoring:
Males and females with a tethered cord can expect the following:
Many people are under the mistaken impression that toilet training is delayed in a child with ARM. While bowel management with enemas is sometimes necessary to allow the child to be clean and not require diapers, the control of the bladder should not be delayed. For more information about toilet training with ARM, click here.
There has been much discussion and debate as to when and why to obtain urodynamics. The purpose of urodynamic studies is to find out whether a child has a neurogenic bladder. For more information on urodynamics, click here.
There are several conditions that require urinary tract reconstruction. You should investigate a surgeon's experience specifically with children with ARM, as urinary tract reconstruction in children with ARM is very different from a standard reimplant surgery or even a reconstruction in a child with spina bifida. For the types of urinary tract reconstruction, click here.
The careful monitoring of children with ARM for potential urologic complications is necessary during infancy and early childhood. Collaborative efforts among related specialty physicians can ensure a holistic approach to diagnosis and treatment of children with ARM.
At Nationwide Children’s, every child diagnosed with a colorectal condition is handled with an individualized treatment plan. For more information or to request an appointment, please contact us.
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