Toilet Training Kids with Anorectal Malformations / Imperforate Anus
Toilet training for stool is the long-term goal for children with anorectal malformations / imperforate anus, although this is not always possible. Parents should be encouraged to use the same strategies for toilet training as in children with normal anatomy.
Strategies for Toilet Training
Between two and three years of age, the parents are instructed to sit the child on the toilet after every meal. The parents are encouraged to do it as a game and not as a punishment. The child should sit in front of a little table and play with favorite toys.
Parents should be encouraged to sit with the child and not to argue or force the child to remain seated. However, if the child gets up, parents should put away the toys.
School Age: Unsuccessful Toilet Training
The child should be rewarded for a bowel movement or voiding while on the toilet. If the child is not successfully toilet trained by school age, there are two alternatives:
- Do not send the child to school for one more year and continue attempts at toilet training.
- Try the Colorectal Center Bowel Management Program for one year, assuming that it will be implemented on a temporary basis. Then, during the next summer vacation, the parents can again attempt to toilet train the child.
Bowel Management Program
The Bowel Management Program consists of the use of enemas or colonic irrigations once a day to clean the bowel and, in some cases, specific dietary recommendations to slow down a colon that demonstrates to be very active.
Most children subjected to posterior sagittal anorectoplasties do not need diet or medications to slow down the colon; most of them have a tendency to be rather constipated.
Patients who have been subjected to other types of surgical techniques may suffer from diarrhea and may, in addition to the colonic irrigations, need constipating diets and / or medication to slow down the colon.
It is unacceptable to send a child with fecal incontinence to school in diapers when his classmates are already toilet-trained.
Children who require diapers or who have accidents while in school because of fecal incontinence are exposed to ridicule from their peers that can lead to adverse psychological sequelae.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
