SOMATIC FUNCTION, MENTAL-HEALTH, AND PSYCHOSOCIAL ADJUSTMENT OF ADOLESCENTS WITH ANORECTAL ANOMALIES

Thirty-three adolescents (aged 12 to 20 years; median, 15) with a corr ected low (n = 17) or high (n = 16) anorectal anomaly were assessed us ing anorectal physiological examination, semistructured interviews (Ch ild Assessment Schedule [CAS]), and questionnaires (Child Behavior Che cklist [CBCL], Youth Self-Report [YSR]). Seven patients, ail of whom h ad low malformations, were totally continent. Twenty-three (70%) had p ersistent dysfunction with staining (n = 12) or intermittent/constant soiling (n = 11). Twenty-four (73%) had flatus incontinence. Fecal inc ontinence correlated negatively with anal canal resting pressure (r = -.58, P = <.001) and squeeze pressure (r = -.54, P < .01). Three adole scents had a permanent colostomy. Nineteen patients (58%) met the crit eria for a psychiatric diagnosis, and impairment of psychosocial funct ion was found in 24 (73%). The degree of psychosocial impairment corre lated significantly with fecal incontinence (r = -.37, P < .05) and fl atus incontinence (r = -.49, P < .01). Continence of flatus correlated significantly with mental health symptom scores (YSR: r = .52, P < .0 1; CAS: r = .53, P < .01). The findings indicated that, in addition to soiling, staining as well as fear of flatus are associated with psych iatric and psychosocial dysfunction among patients with anorectal malf ormations. Optimal treatment of patients with low and high anorectal a nomalies requires somatic and psychological care and follow-up into ad ulthood. (C) 1996 by W.B. Saunders Company