State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations

Abstract

Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.

Is Collaborative Care the Future of Medicine? Lessons Learned from the Care of Children with Colorectal Conditions

“…The causes of soiling are myriad, and the care of these patients requires understanding when fecal incontinence should be anticipated as well as the surgical options available to help a patient achieve continence [49]. Bowel management programs and their techniques have dramatically improved many patients' quality of life and require an institutional commitment to a nursing team [50][51][52][53].…”

Asociación Vacterl

“…(35) Al momento del examen físico rutinario, muchas veces se descubre un ano imperforado completo en el período posnatal inmediato; sin embargo, otras variantes anatómicas tales como la estenosis anal o la atresia rectal pueden parecer anatómicamente normales en el examen inicial y más tarde presentarse clínicamente con signos de obstrucción. (36) Con una radiografía simple lateral, colocando al paciente en posición prono, con la pelvis elevada (por 3 minutos), luego de al menos 18-24 horas de vida, se puede constatar el bolsón rectal y su proximidad a la piel perineal, lo cual puede orientar hacia el tratamiento neonatal en cuanto a la elección entre anorrectoplastia o colostomía. Debe indicarse, además, una ecografía abdominal para evaluar las anomalías genitourinarias acompañantes.…”

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation

“…We present a review of bowel management protocols for patients with functional constipation referred for surgical evaluation. This review includes updates on evaluation and medical and surgical management options in these children and belongs to a series of manuscripts on bowel management aspects for patients with anorectal malformations (ARMs), Hirschsprung disease (HD), spinal anomalies, and functional constipation [23].…”