After the birth of a child, anorectal malformations (ARM) are usually identified quickly. These malformations affect about one in every 4,000-5,000 births, and boys are slightly more likely to have ARM than girls. Once your child is known to have an ARM, he or she should be evaluated by an expert in colorectal and pelvic reconstructive surgery.
Newborn evaluation by a specialist will help your family find out what type of ARM your child has and what type of surgery he or she may need. Your baby will be laid on his or her back for the exam, with knees lifted or rolled up toward the chest. The doctor will check for the number, type and appearance of openings. This helps the doctor get an idea about the kind of ARM your baby has.
By performing this evaluation, the doctor will also be able to tell you what to expect in terms of further evaluations, such as imaging and other tests, and the most likely types of surgery your baby may need. Early evaluations can help determine how complex the ARM is and the likely outcomes from surgery. These details will help your doctor give you information about managing your child's condition in the future.
Diagnosing Your Child's ARM
No exact diagnoses or surgery decisions should be made in the first 24 hours after birth. Instead, your child should be immediately checked and treated for any related emergency problems, such as kidney or heart issues. Once these urgent evaluations are made, your baby should be examined more carefully for the specific ARM diagnosis.
Each type of ARM is different. A detailed exam will tell you the type of malformation and how complex it is. ARMs are usually classified into the following categories:
- Perineal fistula
- Rectourethral fistula
- Rectobladderneck fistula
- Vestibular fistula
- ARM with no fistula
- Anal stenosis or atresia
In addition to identifying the primary malformation, the evaluation will look for other abnormalities linked to your child's ARM. This will impact the plan for surgery and management. Most relevant, are the quality of the sacrum and the spine. If the doctor knows the type of ARM, the sacral ratio and the quality of the spine, he or she can predict future continence.
In order to accurately diagnose your child's ARM, the health care team will perform an ultrasound of the spine, pelvis and abdomen. If further imaging is needed to provide more information, your baby may get some additional radiographs.
Imaging helps surgeons prepare for any operations your child will need. They also help identify malformations or defects that may be health risks later, such as bladder problems.
Preparing for Treatment
The newborn evaluations your baby receives will help determine what kind of operation is needed for short-term treatment of the ARM. Most babies also need follow-up surgeries to address the ARM step by step.
By receiving a thorough newborn evaluation by a specialist in ARMs, you can be sure your doctors have the information they need to treat your baby effectively. In addition, they can begin to understand the potential for future bowel control. The health care team will explain the details of your child's condition and the plan for surgery so that you know what to expect and when. You can also learn about the doctor's recommended treatment plan by reading about infant ARM care.