Anal Atresia (Anorectal malformation)
Anal atresia, which is a very complicated and difficult disease, is examined under the title of anorectal malformation.
What is anal atresia?
Anal atresia is the inability of the anus opening to develop during the development of the baby in the mother's womb or the inability to pass through the muscle complex (sphincter) where it should be. These dolls do not have a butt hole. The last end of the large intestine either ends blindly inside or can open to a different place such as the urinary tract (urethra), vagina.
What are the anomalies accompanying anal atresia?
Although the etiology is not completely clear in patients with anorectal malformation, studies have shown the coexistence of genetic predisposition and multisystem syndromes. It is the most common combination of VACTERL anomaly. In this anomaly, in addition to anal atresia, the baby's esophagus, heart, hands and feet, kidneys and vertebrae should be evaluated. The most common accompanying anomaly is the kidney-bladder anomaly.
What is the incidence of anal atresia?
It is called low and high type according to the place where the end of the hindgut is opened. According to this, its incidence is seen in 1 in 1200 -5000 births. While the low type is seen equally in girls and boys; The high type is seen twice as often in men.
How is anal atresia diagnosed?
The diagnosis is made in the physical examination performed as soon as the baby is born. If the diagnosis is missed in the first examination, within a few days; Families apply to the hospital with complaints such as the baby cannot poop, poop comes from the tip of his penis or from the vagina, the baby's tummy is swollen.
How is anal atresia treated?
After the diagnosis is made, anus is created with a single operation in low-type patients, while three surgeries are required in high-type ones. The first of the three operations is to make the baby poop by mouthing the descending large intestine, which we call colostomy, to the abdominal wall. The second operation is the main operation, and the end of the intestine is formed in the form of anus opening. This procedure is preferred when the baby reaches 9-10 kilos. The final operation is the closure of the colostomy. It is performed 2-3 months after the second surgery.
In recent studies, the mortality rate was found to be 15-20% in high types and 5% in low types. The reason for this is that it is accompanied by more serious additional anomalies.
How does it look after the surgery?
The first thing to do before the operation; to discuss with the family in detail. In general, the expectation of families is always high and that the disease will be completely cured. The most important point here is that even if the surgery performed especially in high-type anorectal malformations has been successful, their children may have poop incontinence and/or urinary incontinence problems. Therefore, before the actual surgical intervention is performed, neural anomalies that may affect bowel and urinary retention and the condition of the pelvic floor muscles (sphincter muscles) should be evaluated.
Poop and urinary incontinence cause very serious social and psychological trauma in children. For this reason, some surgical and/or drug treatments have been applied in children with poop and urinary incontinence for a long time. The main problem here is the incomplete development and weakness of the butt muscles, which we call the pelvic floor muscles. For this reason, the success rate of most of the methods is unfortunately not high.
How do we, as the Children's Bladder and Bowel Disorders Center, treat?
The treatment method we apply in our center is rehabilitation to make the pelvic floor muscles functional and lifestyle changes to retrain the bladder-bowel. We are doing this treatment method, which has just started in the world in recent years, in company with patient-specific sessions conducted by our experienced pelvic floor physiotherapists. The main goal of our sessions is to ensure healthy voiding and defecation in children by making the pelvic floor muscles that control voiding and defecation functional. Our pelvic floor rehabilitation sessions are not just about “biofeedback” treatment. We treat all other muscles that involve the pelvic floor muscles at the same time. Our treatment includes many different techniques such as manual therapy, exercises for the spine, breathing and posture training, biofeedback, neuromodulation. We make the contents of our sessions unique by creating them specifically for each of our patients. Thus, we get faster results with need-oriented treatments.
With this treatment we do, in children;
- To increase the feeling of poop in children who do not have a sense of poop,
- To prevent constipation in children with constipation,
- We aim to reduce or even eliminate poop incontinence as much as possible.
The success of the treatment completely depends on the cooperation of the family, the child, the doctor and the pelvic floor physiotherapist. It is very important for the family and the child to actively participate in the treatment for the treatment to achieve maximum success.