Anorectal Malformations

Many anorectal malformations present complications soon after birth. Some children with an anorectal malformation may not have an initial bowel movement after being born, or they may have irregular bowel movements. It's essential to have a medical team identify these irregularities quickly after birth so a specialist can be brought in to assess and diagnose the issue.

Health problems caused by anorectal malformations

Depending on the type and severity of the anorectal malformation, several problems can occur:

• If the anal passage is narrow or in the wrong location, a child may have trouble passing a bowel movement. This can cause constipation and discomfort.
• If there is a membrane over the anal opening, the baby may be unable to have a bowel movement until the membrane is surgically opened.
• If the rectum is not connected to the anus and no fistula is present, there is no way for stool to leave the intestine. The baby will be unable to have a bowel movement. This could result in bowel obstruction (blockage).
• When the rectum is not connected to the anus but a fistula is present, stool may pass through the fistula instead of the anus. The fistula is too small, preventing stool from passing completely out of the body, which can cause a bowel obstruction. This anorectal problem can also cause urinary tract infections.

How do we diagnose anorectal malformations?

When a baby is born, the doctor performs a thorough physical exam to check if the anus is open and in the proper position. Your child's doctor may also perform tests to determine whether other problems are present, including:

• Abdominal X-rays show the location of the malformation and may help determine if it is high or low in the anorectal area. X-rays also let doctors know if there are any problems with the spine and sacrum (tailbone).
• Abdominal and spinal ultrasounds help your child's doctor examine the urinary tract and spinal column. They may also be used to look for signs of a tethered spinal cord, an abnormality where the end of the spinal cord is abnormally anchored. A tethered spinal cord may cause neurological difficulties as the child grows. Examples of neurological difficulties include weakness and incontinence (loss of bowel or bladder function).
• An echocardiogram is a test your child's doctor can use to determine if there are heart defects.

How do we repair or treat an anorectal malformation?

Treatment recommendations depend on the type of anorectal malformation, the presence and type of other health problems, and the child's overall health. However, most infants with an anorectal malformation will require surgery.

Will my child need a colostomy?

Newborns diagnosed with anorectal malformations may require one or more operations to correct the malformation. An initial surgery is often necessary to create a colostomy so your child has a means to pass stool while preparations are made for a longer-term solution. During the colostomy procedure, your child's surgeon creates a stoma, or opening in the abdomen, through which stool can pass and exit the body.

A colostomy divides the large intestine into two sections and the ends of the intestine are brought through small openings in the abdominal wall. The upper section allows stool to pass through the stoma into a collecting or colostomy bag. The second, smaller stoma is called a mucus fistula. The purpose of the mucus fistula is to drain bowel secretions from the bottom portion of the stoma.

Your child's care team will teach you how to take care of the colostomy and help make the transition from the hospital to home as smooth as possible.

Helpful resources

The Pull-thru Network empowers individuals and families affected by congenital bowel and bladder disorders through support, education and advocacy and helps foster understanding and acceptance worldwide.