Health Library

Anorectal Malformations and Fecal Incontinence

Does My Child Have Sensation Within the Rectum?

What Is a Voluntary Sphincter and Why Is It Important?

The voluntary sphincter is a group of muscles that surround the rectum and anus. These muscles are vital for bowel control.

• In children with anorectal malformations, these muscles are less developed and are not able to keep the stool from leaking out.

• The more complex the anorectal malformation, the sphincter muscles are less developed.

• It is important for the placement of the rectum to be within the limits of the sphincter at the time of the child’s Pull-Through / PSARP surgery.

Are There Things that Help Predict Good Bowel Control?

After the main repair, and for some patients the colostomy closure, the surgeon can predict if the child may have good bowel control.

Indicators of Potential for Good Bowel Control

• Normal sacrum (lowest part of the spine / backbone)
• Well-formed buttocks muscles
• Some types of anorectal malformations. These include: rectal atresia, vestibular fistula, imperforate anus without fistula, rectourethral fistula, cloaca with less than 3cm common channel, perineal fistula.

Indicators of Potential for Poor Bowel Control

• Abnormal sacrum (lowest part of the spine / backbone)
• Flat buttocks (poor muscles)
• The presence of a tethered spinal cord (spinal cord abnormally attached to the spine)
• Some types of anorectal malformations. These include: rectobladderneck fistula, cloaca with greater than 3cm common channel, complex malformations.

What Determines How Well My Child Is Doing?

Children with good bowel control will have:

• Good bowel movement patterns. They will have one to two bowel movements per day with no soiling in between.
• Signs of feeling when passing stool (pushing, making faces)
• Urinary control

Children with good bowel control may have soiling if they:

• Have a viral illness
• Take medicine that causes diarrhea (for example, antibiotics)
• Become constipated

When the cause of the diarrhea has resolved (a viral illness or medicine), they should get their bowel control back.

Children with poor bowel control may have:

• Soiling accidents and passing stool all the time with no control over the bowel movements
• No signs of feeling when passing stool (no pushing, making faces or saying they have to go)
• No urinary control or dribbling of urine

Understanding your child's chances for bowel control may take some time, but it is helpful with the management of care later on in life. Since there are a wide range of defects within the anorectal malformation diagnosis, we should expect a wide range of results of bowel function.

Are Anorectal Defects Linked to Poor Outcomes?

If the child's type of defect is linked with a poor outcome, they will likely have to start a bowel management program with a daily enema to stay clean of stool.

For these children, this program with a daily enema should be started when the child is 3 or 4 years old, or when their peers are out of diapers.

We always give each child the chance to prove their potential for bowel control. Children who have poor bowel control now may become more aware of their bodies as they get older. When this happens, we can try a program that does not have a daily enema.