Th. Diseth et R. Emblem, SOMATIC FUNCTION, MENTAL-HEALTH, AND PSYCHOSOCIAL ADJUSTMENT OF ADOLESCENTS WITH ANORECTAL ANOMALIES, Journal of pediatric surgery, 31(5), 1996, pp. 638-643
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