ANTERIORLY LOCATED ANUS - IS CONSTIPATION CAUSED BY ABNORMAL LOCATIONOF THE ANUS

Anteriorly located anus (ALA) is frequently associated with severe con stipation accompanied by defecation pain. Between 1988 and 1994, the a uthors treated 27 children (26 girls, 1 boy; age range, 0 to 11 years) to surgically correct ALA. The operation was performed according to a uniform protocol to longitudinally divide the internal sphincter musc le from the anal skin level to 2 cm above the dentate line on the post erior wall of the anorectum. For anal reconstruction, any of the conve ntional procedures was employed. Twenty-two of the 27 patients have ha d follow-up in our clinic for 12 months to 6 years (mean, 2.75 years). Eighteen are completely free of constipation and defecation pain and have regular spontaneous bowel movements. The other four require occas ional use of enemas or laxatives. Anal incontinence did not occur in a ny patient. The results of this study suggest that abnormal function o f the internal sphincter is the most likely cause of constipation or d efecation pain in patients with ALA and that internal sphincterotomy i s the cornerstone of surgical treatment. Copyright (C) 1996 by W.B. Sa unders Company