Anorectal Malformations Symptoms, Test and Treatment

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“Anorectal malformation is the birth defect and issue occur in unborn(fetus)baby is developing during pregnancy.”

  • In this case, the Anus and rectum do not develop properly. It occurs more in the boys than girls
  • Ano: means the Anus. This is a hole at the end of the large intestine
  • Rectal: a large part of the large intestine just above the Anus
  • This is the soon after birth, with no anal opening
  • It was swelling in the abdomen
  • No stool pass in 24 to 48 hours of birth
  • In some instances, the anal opening in the wrong place, like closer to the vagina(in the case of a girl)
  • Esophageal defect (the tube that connects the mouth to the stomach does not develop properly)
  • Stool passing through the wrong place such as the vagina, base of the penis
  • Poor digestion
  • Urinary tract infection
  • Abnormality of the spine
  • Genetic problem

Table of Contents

Can imperforate anus be fixed

An anorectal malformation can be corrected with the surgical procedure. Mild defect of the child does not create any problem. Those children who are having complex surgery can also get control over the bowel movement. Initially, constipation should be avoided.

Classification of anorectal malformation

It is done into three groups in the infants without a normal anus

1.With a visible abnormal opening of the bowel

  • Anal stenosis(narrowing of the anal), anoperineal fistula(connect perineum to anal), anovestibular fistula in female

2.With an invisible but with the opening of the bowel 

  • Rectovaginal fistula in females (the connection between the lower portion of the sizeable intestine-your rectum- your vagina.
  • Rectourethral fistula in male (the connection between urethra and rectum)
  • Rectovesicular fistula (an abnormal connection between the rectum and urinary bladder)
  • No manifested opening of the bowel

Persistent anal membrane, rectal atresia

It can be classified into two groups based on the levator ani muscle, which is the primary muscle of fecal control.

Supralevator or High Anorectal Malformations:

when rectum terminates above the lavatory ani, Power is seen in rectal atresia, rectoprostatic fistula, rectovaginal fistula; about 30 % of children with high ARMs or associated genitor-urinary fistula achieve bowel continence.

Translator or low Anorectal Malformations:

when the rectum terminates below the levator ani muscle, e.g., in any cutaneous fistula and anovestibular fistula. About 90% of children with low ARMs achieve bowel continence.

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Signs and Symptoms

  • It is usually diagnosed immediately after birth by the person conducting the delivery or within hours by the caregivers.
  • The specific features for specific anomalies are …
  • Imperforate anal membrane : infants fails to pass meconium(newborn’s first stool, the greenish bulging membrane is seen on examination. Bowel and sphincter return to normal after excision
  • Anal stenos are: It accounts for 10% of all ARMs, the baby may pass ribbon-like stools with difficulty as the anal opening is very small.
  • Anal agenesis: It presents with the only dimple. Usually, fistulas are found in the urethra in males and perineum or valve in females. Intestinal obstruction develops if there is the absence of any fistula.
  • Rectal agenesis: This condition accounts for 75%. It present with. A fistula may communicate with the posterior urethra in a male baby and a female baby with an upper vagina. Associated major congenital malformations are common.
  • Rectoperinal fistula: it is found as a small orifice in the perineum, usually anterior to the center of the external sphincter; in male baby, it is located close to the scrotum, and in the female vulva.
  • Rectovaginal fistula:- It present with communication between the rectum and vagina and stool passed through the vagina.

Read: Vaginal disorders: Symptom, Causes, Diagnosis And Treatment

Diagnosis

  • Physical examination of the neonates(newborn).
  • X-ray of the spine to catch bone abnormalities.

USG helps to

  • locate the rectal pouch
  • X-ray with the inverted infant after 24 hours of age
  • Urinary fistula can be diagnosed by urinary examination.
  • Surgery is done to correct the malformation.

Treatment

Treatment depends on how severe the condition is,

Reconstructive depends upon the types of anomalies and sex of the infant.

In low ARMs, rectal cutback angioplasty or Y-V plenty is done for male infant and female dilatations of the fistula with the definitive repair or perineal angioplasty.

In high ARMs, a colostomy is done in the neonatal period, followed by definitive reconstructive surgery.

Some children will experience problems with massive constipation. Take some necessary action for stool pass like toilet training, laxatives sometimes essential to reduce constipation later in life. Give more fiber in the diet, and following regular care is needed.

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