Classification of Anorectal Malformation

Anorectal malformation is a condition where the anus, which opens into the rectum the end of the large intestine, is missing, is malformed, or has a blockage that doesn’t allow feces to pass from the body.

­The condition is also called imperforate anus and is diagnosed at birth. One out of 5,000 babies are born with the condition, and as of now there's no way to prevent it. The complete lack of an anus in the baby is considered a medical emergency.

Anorectal malformation has a low type and a high type.

The low type usually involves an unnatural opening in the body, also called a fistula, that needs to be repaired. The anus may also be extremely narrow. In this case anal dilation will be all that’s necessary and surgery can be prevented, unless the anus is in the wrong place. Sometimes the anus is missing altogether or the rectum ends in a cul-de-sac and doesn't connect with the large intestine at all.

In the high type, the anus has openings into the bladder or the genitalia. In another form, the baby’s vagina, rectum, and bladder all empty into one passage. The condition should be able to be detected immediately through a physical examination, but if it isn’t, it might manifest as the baby not being able to pass stool within a couple of days after birth, or stool passing out of the genitals or urethra. Urethra are the tubes leading to the bladder. There may be abdominal swelling caused by a blocked intestine.

A baby born with this condition can have other medical difficulties as well, especially in the genitals, bladder, urethra, heart, kidneys, esophagus, limbs or spine. Surgery can often correct anorectal malformations, but the condition can be such that the organs in the body that were improperly connected to the anus will need surgical repair as well. Sometimes a colostomy is needed, though temporarily. A colostomy is the creation of an exit for feces to leave the body. The baby has to live with the colostomy for a few months before they’re big and strong enough for the surgery, which, depending on the severity of the malformation, can be invasive and complicated. The recovery period can take months and can be challenging, especially for a little child and their family.

Despite this, the prognosis after surgery is very good, though children who’ve had this condition may suffer from constipation or urinary incontinence. Even children with a complicated case of anorectal malformation can still control their bowels, but will have to follow a regimen where they have to take stool softeners and enemas and eat a high fiber diet. They might have to endure follow-up surgery as well.­



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