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Colorectal and Urogenital Care
Cloacal malformation (Cloaca)
We see more, treat more and heal more kids than any other hospital in the region.
What is cloaca?
A cloacal malformation, or simply cloaca, is an anorectal malformation that affects the rectum, urogenital tract, vagina and urethra in females. Females are typically born with three perineal openings: the urethra, vagina and anus. Children born with a cloaca only have one opening because the urethra, vagina and rectum are joined, creating a common channel instead of three separate ones. They may also have more than one uterus and vagina.
Types of cloaca
The length of the common channel may vary between 1 cm and 10 cm. The length impacts the patient’s health outlook and determines the type of surgery that a child will need. Usually, the shorter the common channel, the better the health outlook for bowel and urinary control will be.
Health problems associated with cloaca
- Hydrocolpos: At birth, about 30% of infants have hydrocolpos, which is an abnormally swollen vagina caused by the buildup of fluid and mucus inside the vagina.
- Urologic concerns: About 50% of infants have urologic problems, such as hydronephrosis, vesicoureteral reflux, an absent kidney or megaureter (enlarged ureter). Ureters are tubes that carry urine from the kidneys to the bladder.
- Gastrointestinal problems: About 11% of infants with cloaca will have esophageal atresia and 3% will have duodenal atresia. Esophageal atresia is a condition in which the esophagus does not develop properly. Duodenal atresia is a condition in which the small bowel does not develop normally.
- Heart problems: About 30% will have heart problems such as atrial septal defect, tetralogy of Fallot and patent ductus arteriosus. Patent ductus arteriosus is an open connection between the aorta and the pulmonary artery.
- Spinal problems: About 25% of children will have a tethered spinal cord.
Why choose Children's Hospital Colorado for your child’s cloaca treatment?
Our International Center for Colorectal and Urogenital Care (ICCUC) is internationally renowned for its expert treatment of anorectal malformations, including cloaca. Our surgeons have been perfecting the surgical technique used to treat cloaca and other anorectal malformations for decades. Surgeons worldwide continue to look to the ICCUC for guidance and the latest treatments for these conditions.
Children’s Hospital Colorado applies a multidisciplinary approach to diagnosing and treating children with anorectal malformations. Our team comprises pediatric specialists, such as urologists, gynecologists, nephrologists, psychologists, neurosurgeons and orthopedists. This multidisciplinary approach ensures your child gets the comprehensive care they need to ensure the best outcomes.
What are the signs and symptoms of cloaca?
Instead of three distinct openings in the perineum, there is only one. Patients may also have abdominal swelling due to hydrocolpos.
What tests do we use to diagnose cloaca?
It’s possible to diagnose cloaca using ultrasound before a baby is born. While a prenatal diagnosis is not always possible, our Colorado Fetal Care Center has some of the best imaging technology available.
Some infants are diagnosed during a physical exam after birth. These tests are commonly used to identify any physical anomalies during the first 24 hours of life:
- An echocardiogram to identify heart defects
- Abdominal and sacral X-rays to evaluate bowel distension (dilation) at birth and to rule out signs of esophageal or duodenal atresia, as well as hemivertebrae or extra/missing ribs. The sacral X-ray allows us to calculate the sacral ratio, which affects bowel control.
- An ultrasound of the kidneys, pelvis and spine to evaluate the kidneys, check if the vagina is distended or swollen,and to rule out a condition called tethered spinal cord.
How do we treat cloaca?
Cloaca requires a surgery called posterior sagittal anorecto-vagino-urethroplasty (PSARVUP). During PSARVUP, the surgeon separates the urethra, vagina and rectum so there are three perineal openings, instead of one. The main reconstructive surgery will be done when your child is about 2 to 6 months of age.
Usually, on the second day of life, babies with cloaca will have surgery to create a colostomy, a surgical procedure that allows your baby to pass stools. They will also have a hydrocolpos drainage to decompress the vagina if needed.
Once we see that your baby is growing well, we can plan for PSARVUP surgery. The type of surgery your child will have depends on the common channel length. Your child’s care team will also address any other health problems associated with cloaca.
Helpful resources
The Pull-thru Network empowers individuals and families affected by congenital disorders like cloaca through support, education and advocacy and helps foster understanding and acceptance worldwide.
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Stories
Every child we help has a story
We’ve helped many children with a range of anorectal malformations. Learn about the different conditions we treat and hear the stories of the children and families we’ve helped.