Anorectal Malformations

Anorectal malformations encompass a type of birth defect in which the anus and the rectum do not develop properly.These abnormalities may include one or more of the following:

  • The anal passage may be too narrow
  • The anal opening may be blocked by a membrane
  • The rectum may not connect to the anus (imperforate anus)
  • The rectum may be connected to a part of the urinary tract through a fistula

At the Colorectal Surgery Program, part of C.S. Mott Children’s Hospital at the University of Michigan, we provide comprehensive, multidisciplinary care for children with anorectal malformations.Our dedicated team of specialists evaluates and will create a customized treatment plan to begin your child’s individualized treatment plan immediately. We offer a truly multidisciplinary approach to caring for children, going beyond treatment and management of symptoms to support your child throughout childhood and even into adulthood.

Symptoms of anorectal malformations

During a normal bowel movement, stool passes from the large intestine to the rectum, and then to the anus.  Nerves and muscles help control when the bowel movement occurs and help the child to sense the need for a bowel movement.Anorectal malformations cause abnormalities with this normal bowel movement process.  A child may have a difficult, painful time passing a stool.  In most cases, he or she may not be able to have a bowel movement at all.  Other times, stool can enter the urinary tract instead of the anus, causing urinary tract infections.

Diagnosing anorectal malformations

Diagnosis begins with a thorough health history and a comprehensive physical examination. Some testing will be required and may include:

  • Abdominal x-ray to identify a lack of stool in your child’s large intestine as well swollen segments of the large and small intestine.
  • Abdominal ultrasound to view internal organs and assess blood flow through various vessels

Treatment for anorectal malformation

Every child’s treatment plan is individualized, based on the patient’s needs and severity of disorder, utilizing cutting-edge technology and the latest research.Surgery will be necessary to repair the deformity.  Our Pediatric Surgery team will work in collaboration with other surgical specialties, including pediatric urology, gynecology and pediatric gastroenterology.  The type and number of operations necessary depends on the type and extent of abnormality your baby has.

  • Narrow anal passage: A procedure known as anal dilation may be used to help stretch the anal muscles, allowing for easier, less painful bowel movements. 
  • Anal membrane: The membrane covering the anal opening will need to be surgically removed.  Anal dilations will also be necessary to prevent narrowing of the anal passage.
  • Lack of rectal connection:  A series of procedures may be required to create an appropriate connection.  A colostomy will be created to allow for stool to be collected in a bag outside the abdomen.  The next step is to attach the rectum to the anus.  The final step may be performed 2-3 months later, allowing for the surgeon to close the colostomy so the child will start passing stools through the rectum.

University of Michigan surgeons specialize in minimally invasive techniques whenever possible. In addition, we are the one of only two programs in the world to offer the surgical treatment of imperforate anus using MRI surgical guidance to allow for optimal positioning of the new anal rectal canal to minimize muscle deficiency and continence issues.

Depending on the severity of the malformation, your child may have varying levels of long-term care needs. Importantly, our Colorectal Surgery Program will provide this long-term care throughout his or her childhood.

Children whose deformity involved an anal membrane or a narrow anal passage are usually able to gain good control over their bowel movements after repair of the anorectal malformation.

Some infants may become constipated. To avoid this, we encourage following a high-fiber diet. Laxatives may be required prior to the age of potty training.In cases of severe anorectal malformation, the child may benefit from participation in our bowel management program to help them achieve control over their bowel movements and prevent constipation.

It is not unusual for some children who have been treated for anorectal malformations to be slower than others to gain bowel control during toilet training.

Occasional, a child who has had a previous anorectal repair may have difficulty controlling urine and develop repeated urinary tract infections.  Renal ultrasound and VCUG (special bladder x-ray) exams can help clarify what might be causing these difficulties and help us work with you to correct the problem.

Once your child is a part of our Colorectal Program we will follow them throughout childhood and into early adult life to ensure the best possible quality of life.

Discover the Michigan Difference in pediatric colorectal surgical care.For more information or to make an appointment, call 1-877-475-MOTT (1-877-475-6688).