Colorectal Center Parent Education Topics

Study and Management of Children With Fecal Incontinence Secondary to the Treatment of Imperforate Anus

If your child suffers from the inability to control bowel movements (fecal incontinence) or urination (urinary incontinence) or any other functional consequences secondary to the treatment of an imperforate anus, you may wish to have the child's medical treatment reviewed at the Colorectal Center at Cincinnati Children's Hospital Medical Center.

The first step is to try to pull together all your child's medical records. The most important documents are the operative reports and all previous X-ray films (the actual X-ray films themselves and not just the reports describing the films). Without having this medical information, the medical team at the Colorectal Center will not be able to conduct a thorough review of your child's medical condition and discuss management plans, operative procedures, and the prognosis for your child.

The medical records should all be sent by express mail or express delivery to the Colorectal Center at the address listed at the end of this document.

Diagnostic Tests To Be Reviewed

It will take at least one week for us to review all this medical information. Following the review, a diagnostic plan will be outlined. If previous X-rays are very old or are not technically accurate, it may be necessary to take additional X-rays and conduct other diagnostic tests.

The most common diagnostic tests used for children with an imperforate anus are:

X-ray films of the sacrum, the end of the spine that forms part of the pelvis
X-ray films lumbar spine
Voiding cystourethrogram, an X-ray of the urinary bladder and urethra after the injection of a contrast medium that allows these structures to be more clearly seen
Contrast enema performed with water soluble contrast material and without previous bowel preparation
Magnetic Resonance Imaging (MRI) study of the pelvis and the spine

MRI Study

The MRI study of the pelvis is done following a specific protocol called "Peña-Patel," designed to determine the location of the rectum and its relationship to the sphincter, a ring-like band of muscles that open and close the anus. If you decide to have this study done at a medical facility closer to your home, please ask the radiologist that will be performing the study to contact us for a written description of our protocol. The spinal study by MRI is done with the purpose of making a diagnosis of a defect called tethered cord. Frequently associated with anorectal malformations, tethered cord is the abnormal attachment of the spinal cord to the bones of the spine.

Contrast Enema

The contrast enema uses a special type of enema fluid that shows up on an X-ray. This test is done to determine the length of colon and the colonic motility, the movement of food through the colon. This information is very valuable information in deciding if a bowel management plan is indicated and, if so, in formulating a plan that will most benefit the patient. The study should never be done with barium but with material that is soluble in water. It is also important to obtain a picture after the evacuation of the contrast material.

Voiding Cystourethrogram

The cystourethrogram, performed after voiding the bladder, is necessary because approximately 50% of all patients with anorectal malformations have associated urologic defects. These defects need to be known prior to surgery since sometimes the operative repair procedures for anorectal malformations can change the anatomy of the urethra and bladder.

X-Ray

The X-ray film of the sacrum allows us to determine the original prognosis for the malformation that your child had at birth.

You Will Be Contacted for an Appointment

Once we review all these studies and delineate a specific plan, the family will be contacted to make an appointment. The normal routine is for X-ray studies to be scheduled first, followed by a consultation. This will allow us to determine whether your child will benefit from surgery or a bowel management program.

Bowel Management Program

If we determine that your child may benefit from the bowel management program at Cincinnati Children's, we will recommend the type of bowel management your child needs and your child will be seen daily by a pediatric surgery nurse clinician. Over a period of one week, physicians, parents, and nurse clinicians will work on developing a bowel management program to keep your child completely clean for 24 hours. If your child also suffers from urinary incontinence, a specific program will be implemented to keep the child completely dry.

If an operation is indicated, operating room time will be scheduled. More information about scheduling, fees, and payment can be discussed when you make the initial appointment to bring your child to the Colorectal Center at Cincinnati Children's Hospital Medical Center.