Babies with anorectal malformations need surgery, regular follow-up visits and sometimes other treatment. At Seattle Children’s, our surgeons partner closely with other experts from Reconstructive Pelvic Medicine (RPM) to provide your child’s care. If your child has other related problems, like problems with their urinary tract or genitals, a team of specialists will work together to meet your child’s needs.
After your baby is born, they can be transferred to Seattle Children’s Level IV Neonatal Intensive Care Unit (NICU), where they’ll receive the highest level of care.
Before surgery, we will give your baby 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.
Surgery for Imperforate Anus
Your baby will need surgery so stool can leave their body properly. Your baby may also need surgery to repair channels that connect their rectum to other body structures, such as the urinary or genital tract.
The type and number of surgeries depend on your baby’s condition. For example, surgery may be less complex if the rectum ends at the skin very near the normal site of the anus. In this case, your baby may need a single operation within a few days after birth. Surgery may be more complex if the rectum ends higher or connects to other structures. In this case, your baby will need other operations before anal repair.
There are three basic goals of surgery for imperforate anus:
- To detach the rectum from other structures and to repair these structures, if needed
- To create an anus in the normal place (anoplasty)
- To pull the rectum down to the new anus and connect it
We will give your child medicine to make them sleep without pain during the surgery (general anesthesia). The length of the surgery depends on how complex the surgery is. Your baby’s surgeon will explain what type of surgery your baby needs and how long it will take.
Some babies need time to grow before they can have surgery to correct a complex malformation. This makes surgery easier and safer for your baby. While waiting, these babies need a way for stool to leave their bodies, so surgeons perform an operation called a colostomy.
Surgeons make two small openings in the child’s belly. Each opening is called a stoma. Then, they cut through the intestines and attach the ends of the intestines to the openings. One opening lets stool (feces) pass to a pouch attached on the outside of the body. The other opening lets out normal mucus made in the intestine.
If your child needs a colostomy, you will get step-by-step details about how to care for the stoma and change the pouch. In most cases, the colostomy is temporary.
Care Right After Surgery
After surgery for imperforate anus, we will give your child pain medicine to make them comfortable. The length of your baby’s hospital stay after surgery will depend on how complex their problem is. Usually, children who do not have other health problems stay five to seven days.
The surgery team will teach you how to care for incisions, how to feed and bathe your child and what to watch for when your child goes home from the hospital.
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.
At the first follow-up visit, the surgeon will perform anorectal dilation and teach you how to do it at home. Dilation means passing a very small, smooth rod into the baby’s anus to gently stretch the opening. This procedure keeps your baby’s new anus from getting too narrow as it heals. Your baby will need dilation every day for several weeks to help prepare for the surgeon to close the colostomy. We will make sure you are comfortable with how to do it at home.
Both before and after surgery, your child will have a team of specialists, like urologists, gynecologists and gastroenterologists, to plan and provide their care. As your child recovers from surgery, the team will continue working together to understand and meet your child’s needs — not only in the early days and weeks, but also as your child gets older.
After surgery and dilation, most children develop good bowel control. But most will have some bowel problems — like constipation or fecal incontinence ( “accidents”) — off and on throughout their lives. Ongoing care from an expert team can help with these problems.
Our goal is to follow your child until they reach college age to help ensure they are healthy and living to their full potential. The RPM team at Seattle Children’s works to monitor and treat problems related to imperforate anus in babies, children, teens and young adults even after surgery.
Your child will need to come back for follow-up visits on a regular basis to check their health. If your child is doing well, these visits may happen only once a year. If your child is having any bowel or other problems, we may see them more often for a while to provide treatment.
For bowel problems that might happen after surgery, we offer a range of treatment options, including:
- Using medicines and changing your child’s diet, activity level and toilet habits to reduce constipation or incontinence
- Using biofeedback to help your child learn to use their new anus
- Using devices to stimulate the nerves in the intestines
- Taking part in our one-week Bowel Management Treatment Program
- Having another surgery to improve bowel control, if needed
Our treatment approach is tailored to your child’s and family’s needs.