Imperforate anus in newborn is a congenital anus defect. In newborns, faeces usually pass from the large intestine to the rectum and from there through the anus outside. In some babies, the area near the anus does not develop while baby is in the mother’s womb. As a result, some babies have their anus completely closed or in a different place than normal.
So let’s find out now about imperforate anus in newborn and its seriousness and treatment.
What is Imperforate Anus in newborn?
The imperforate anus is the closed anal canal or the anal canal is at different place than normal. Some newborn girls have an abnormal passage between the rectum and urinary tract, while boys have an abnormal passage between the rectum and urinary tract.
In newborns, the disease affects one in 5,000 babies. Imperforate anus is more common in boys than in girls. Some girls have only one passage of the anus, the urethra and the vagina. It is called as cloeca. The disease appears in the fifth to seventh week of life when the baby is in the mother’s womb.
What is the reason for imperforate anus?
The cause of imperforate anus in newborn babies is not clear, but in some babies the disease can be caused by heredity. Sometimes mutations can also cause the baby to get the disease along with some other ailments. It is called VACTERL.
These include V is a vertebral defect (spinal cord problem), A is a closed anus, C is a cardiac defect(Heart), T is an abnormal passage between the esophagus and trachea (Tracheo-esophageal fistula), E is a closed esophagus, R is a kidney defect, and L is an abnormality in some limbs. It is very important to check if there is any disease in the baby which is born with imperforate anus.
- Vertebral Defect : There is defect in vertebral bones such as absent vertebral bone or fused vertebral bone which may cause compression of spinal cord.
- Anal atresia : Anal atresia means absent anal opening. It is also known as absent anal opening.
- Cardiac Defect : Ventricular septal defect is the most common cardiac defect in VACTERL anomalies. Other cardiac defects associated are atrial septal defect, patent ductus arteriosus, tetralogy of fallot.
- Tracheo-esophageal Fistula : Abnormal connection between trachea and oesophagus is the most common abnormality in VACTERL defects.
- Esophageal atresia : Atresia means abnormal narrowing or absent opening in esophagus. Due to this condition baby is not able to digest food and vomit it out recurrently.
- Renal abnormalities : Renal abnormalities like hydronephrosis ( swelling over kidney), renal dysplasia ( malformation of kidney), hypospadias ( abnormal opening of urethra) can be seen in such patients.
- Limb abnormalities : Absent or displaced fingers, extra digits or fusion of digits seen in patients.
What are the types of Imperforate Anus?
Since the imperforate anus in newborn is a type of deformity, it appears in different forms. Three types of deformity appear in this disease.
1) High type – In this disorder the anus is closed and the rectum is closed above the abdomen. This type of fistula is more likely to develop in newborn babies with imperforate anus.
2) Intermediate type – The anal canal is closed in the lower part of the abdomen and there is a possibility of fistula in such babies.
3) Low type – The anal opening is present at unusual place and sometimes there is a fleshy membrane over it.
What are the symptoms of Imperforate Anus?
The symptoms of imperforate anus in newborn are congenital and may be as follows.
1) Lack of anal opening
2) Anus is not at normal place, it is in an unusual place. Being close to the vagina in girls.
3) Stool is not passed by the newborn baby in the first 24 hours.
4) The baby’s stool coming out from another place means coming out through the urinary tract, vaginal tract, and the sac under the penis. If there is a fistula in the intestine and urinary tract, then it comes out of the urinary tract. If a fistula is formed in the intestinal and vaginal tract, it comes out of the vaginal tract.
5) There may be distension of the abdomen.
If the baby is not diagnosed in time, the baby’s symptoms may increase, such as bloating, lethargy, and vomiting. In some babies, VACTERL diseases are also look out to rule out any other abnormalities. The following diseases are also seen in 50% of babies.
1) Duodenal atresia – In this disease the initial part of small intestine is not developed.
2) Hirschprung Disease – In this disease the nerves in the last part of the large intestine are not developed.
3) Down syndrome – In this disease, children are less likely to understand what is being said. Their intelligence is somewhat low and they have distinct facial features.
How is imperforate anus diagnosed?
The diagnosis of imperforate anus is made by the doctor based on the examination of the baby’s anus. At birth, such babies do not have an anal opening or have anal opening at different place. In some babies, the disease is detected by sonography performed while the mother is pregnant.
Once diagnosed, doctors perform the following types of tests to understand what type of anorectal malformation is.
1) Abdominal X-ray – X-ray of the abdomen shows the location of the anorectal malformation, which means the type of imperforate anus. If there is any deformity in the vertebrae, that can be rule out.
2) Abdominal sonography – Kidney and urinary tract abnormalities can be detected in sonography. Reproductive system abnormalities in girls are also detected in this investigation.
3) Spinal Sonography – This sonography shows some abnormalities in the spine as well as the spinal nerve if it is not fully developed. This is called the tethered spinal cord. In this disease, the baby does not have control over urination and potty and also has weakness in the legs.
4) MRI – This examination is done to understand the problems in the spine as well as the tethered spinal cord.
5) Echocardiogram – 2D echo is done to understand the abnormalities in the heart.
It is not important to do all of the above immediately. The doctor can examine the baby which are needed for the imperforate anus as it is kind of emergency so the baby’s life can be saved if the disease is treated in time.
What is the treatment of Imperforate Anus?
The treatment of imperforate anus is an operation because the baby does not have a place to pass stool and stool started to accumulate in the intestines. As a result, the intestines may rupture and spread the infection to the stomach, increasing the risk to life.
In case of low type imperforate anus, only one surgery is needed.
Since the intermediate type and the high type are complex, three types of operations are performed to correct them.
1) In order to save the life of the baby at the beginning, a way for passage of stool is being prepared to come out on the baby’s abdomen. This operation is called a colostomy.
2) In the second operation, the baby’s anal opening is prepared. This operation is called anorectoplasty.
3) In the third operation, the place of stool (stoma) on the abdomen is closed so that the baby starts passing stool from the normal place. This operation is called a colostomy closure.
By now you must have understood exactly how to treat an imperforate anus in a baby and save his/her life.
So let’s take a brief look at the different operations that parents need to know.
1) Colostomy – Colostomy is very important to save the life of the baby because the baby’s life is in danger as there is no place to pass the stool in the baby. This saves the baby’s life. In this operation, surgeons prepare the stoma. In this stoma, the upper part of the large intestine and the lower part of the large intestine are connected to each other. It is called as stoma.
Stool comes out of the upper part of the intestine and also sticky mucus comes out of the lower part of the intestine. Special care should be taken at home as the doctor explains how to take care of the stoma. This operation is performed immediately after birth and as soon as the imperforate anus is diagnosed.
2) Anorectoplasty and Pull through – This operation is performed two to three months after colostomy. Anorectoplasty involves closing the way for a fistula to form in the baby’s anal canal. This stops stool to pass through the urinary tract as well as the vaginal tract and at the same time the rectal tract is also created. This operation is called posterior sagittal anorectoplasty.
Also, in a pool-through operation, the anus is brought down and a new anal opening is made. The doctor tells to enlarge the part of the anus daily with a steel rod (dilator) so that the path he has created does not become narrow. This is called anal dilation. Anal dilation may have to be done for a few months.
3) Colostomy Closure – In this operation, the stoma opening made on the baby’s abdomen is closed. Also, the upper part of the large intestine is connected to the lower part of the large intestine by sutures. So that the baby starts to pass the stool from a normal place.
After this operation, a feeding tube is inserted into the baby’s nose. Also, the baby is not given any oral food. But the baby is given as much Intravenous fluids as the baby needs according to its weight.
The nasal feeding tube is kept open until the stitched bowel begins to function and baby passes stool through anal opening. The bile that accumulates in the stomach is expelled through feeding tube. The baby is discharged from the hospital as soon as the baby’s anal opening begins to work normally.
It is very important to follow up with the doctor who performed the operation frequently even after the above three operations. Because the nerves at the site of the operation are not developed properly, the baby may need proper toilet training. It is very important for parents to give toilet training to their baby at the age of three.
It is very important to take good care of the baby with Imperforate anus. It is very difficult for the parents to look the baby suffer from such a trauma but the operation by a specialist pediatric surgeon saves the life of the baby and also makes the baby’s life normal. It is also important for parents to keep patience till all the procedures are done.
What complications can occur in babies who have undergone Imperforate Anus surgery?
Some babies may suffer from constipation because the nerves in the place where the baby was operated do not develop normally. Also, some babies have no control on potty. But after taking the following measures, the problem of the baby can be reduced.
1) If the baby has constipation, the doctor may prescribe medicine to pass the potty without much difficulty.
2) It is very important to change the diet of the baby. The diet should include fibrous foods and avoid fatty foods and drink plenty of water.
3) It is very important to give proper toilet training to the baby.
If parents follow above steps properly then it will be easy for their baby to live life without much problems.
Does imperforate anus is a kind of emergency?
Due to the imperforate anus in newborn, there is no space for the baby to pass stool, so it gets stuck in the intestines and the intestines can swell and rupture, endangering the baby’s life. Therefore, imperforate anus is an emergency and need surgery urgently.
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