Predicting future continence in children with anorectal malformations

For children born with anorectal defects or Hirschsprung disease, doctors are able to predict the potential for bowel control fairly accurately, even during infancy. Once a child’s reconstructive surgery has healed, physicians will evaluate several factors and give caregivers an idea of what to expect. This is particularly important to help parents set expectations around potty training, and to help them prepare for the need to adopt a long-term bowel management program.

Factors that indicate good prognosis for future bowel control

• normal sacrum (the large triangular bone at the base of the spine)
• good sphincter muscles
• anorectal malformation types of rectal atresia, rectoperineal fistula, imperforate anus without fistula, small cloacas and rectourethral bulbar fistula
• good bowel movement pattern, of 1-2 well formed bowel movements per day
• evidence of sensation when passing stool (ability to push)

Factors that indicate a poor prognosis for future bowel control

• abnormal sacrum
• poor sphincter muscles
• anorectal malformation types including rectobladderneck fistula, rectoprostatic fistula, larger cloacas, complex malformations
• constant passing of stool
• no sensation (no pushing)
• urinary incontinence, dribbling of urine

Whether the prognosis for bowel control is considered good or poor, it’s important to note that most children who have undergone surgery to correct anorectal malformations or Hirshsprung disease will need some type of consistent dietary or medical intervention to prevent constipation or true fecal incontinence. The good news is that in most cases, good bowel control can be established, and these kids can go on to live confident, independent lives.