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Digestive and Gastrointestinal Conditions

Imperforate Anus and Anorectal Malformations


Babies with imperforate anus and anorectal malformations need surgery so waste can leave their bodies properly. The type of surgery depends on your baby's condition. For example, surgery may be relatively simple if the rectum ends in a closed pouch very near the normal site of the anus. In these cases, your baby may have surgery within a few days of birth. If the rectum ends higher or if it connects to other body structures, surgery may be complex. In this case, your baby will need other operations first, and anal repair likely will be delayed for a few months.

After your baby is born, they can be transferred to Seattle Children’s Level IV NICU, where they'll receive the highest level of care after treatment. Seattle Children’s is the first hospital in Washington to have a Level IV NICU.

Surgery for Imperforate Anus

There are three basic goals of surgery for imperforate anus:

  • If needed, to detach the rectum from other structures, such as the urethra or vagina, and to repair these structures
  • To create an anus in the normal place on the outside of the body, an operation called perineal anoplasty (pronounced pair-in-EE-ell AIN-oh-plast-ee)
  • To pull the rectum down to the new anus and connect it, called a pull-through operation

Surgery to fix the anus

Before your baby has surgery to fix the anus and related structures, we will give fluids through an IV (intravenous) line. A baby who has no anus will not be able to eat, and the IV fluids provide nutrition.

Your baby will also need a tube that passes through the nose into the stomach (nasogastric tube, or NG tube). This tube can be used to keep air out of the stomach so your baby is less likely to vomit.

When it's time for surgery, we will give your child medicine to make them sleep without pain during the surgery (general anesthesia). The length of the surgery varies depending on how complex it is. Your baby's surgeon will explain the steps and give you an estimate of how long it will take.

After surgery, your child will be in the recovery room for an hour or longer. We will give your child pain medicine to make them comfortable.

The length of your baby's hospital stay will depend on the severity of their problem.

About two to three weeks after surgery, the surgeon will see your child for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.


Some babies need time to grow before they can have surgery to correct imperforate anus. This allows their rectum and other structures to get bigger so that they are easier for the surgeon to see.

While waiting, these babies need a way for solid waste to leave their bodies. Doctors perform a surgery called a colostomy (pronounced cull-OST-uh-mee) so waste can get out of your baby's body. In most cases this is a temporary situation. After your baby has surgery to fix the anus, rectum and related problems, surgeons will close the colostomy.

When it's time for surgery, we will give your child medicine to make them sleep without pain (general anesthesia).

During a colostomy, surgeons create two small openings in your child's belly. Each opening is called a stoma. Then, they cut through the intestines. Surgeons bring the upper part of the intestines to one stoma and attach it. This allows waste to come out of the body into a pouch attached on the outside.

Next, the surgeons bring the lower part of the intestines to the other stoma. This provides an opening to clean the lower intestines.

If your child needs a colostomy, you will get step-by-step details about how to care for the stoma, change the pouch and clean the intestines.

After surgery for imperforate anus

Your child may need follow-up care at the surgery clinic for many years. Your child will also need care at home to help the new anus develop properly. Our Reconstructive Pelvic Medicine Clinic brings together many healthcare providers who work as a team to provide long-term management.

As your child gets older, you may need to train them in bowel control. Your child may also need a bowel management plan. This means they may need to use enemas or stool softeners, eat high-fiber foods or take other steps to keep their bowels working well and to prevent “accidents” (incontinence). Some children will need further corrective surgery.

Your child’s healthcare team will teach you how to manage the care your child needs. Most children who have surgery develop good bowel control. The most common long-term intestinal problem for children who have had imperforate anus is having a hard time with bowel movements (constipation) or having “accidents” (incontinence). Most problems can be overcome. Close follow-up with your child’s surgery team is the best way to manage these problems. We have a one-week Bowel Management Treatment Program for children who have trouble with bowel control.

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Summer 2014: Good Growing Newsletter

In This Issue

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Download Summer 2014 (PDF)