EFFECTS OF ANAL INVASIVE TREATMENT AND INCONTINENCE ON MENTAL-HEALTH AND PSYCHOSOCIAL FUNCTIONING OF ADOLESCENTS WITH HIRSCHSPRUNGS-DISEASEAND LOW ANORECTAL ANOMALIES

Background/Purpose: Recent studies of adolescents with Hirschsprung's disease (HD) and low anorectal anomalies (LARA) showed persistent impa irment of fecal control in both groups, but very different mental and psychosocial outcome,. Methods: To explore possible reasons for these differences, 19 adolescents with HD (aged 10 to 20 years; median, 16) operated on by the Duhamel technique were compared with 17 adolescents with LARA (aged 12 to 20 years; median, 15), The 36 adolescents were assessed for treatment procedures, bowel function, and mental and psyc hosocial outcome by data collected from medical records, physical exam ination, semistructured interview, and standardized questionnaires, Th e parents of 30 adolescents were also interviewed and completed questi onnaires.Results: Duration of anal invasive treatment procedure and cu rrent bowel function were associated with mental and psychosocial outc ome, The treatment variable, duration of anal dilation, was the most s ignificant predictor of the adolescents's mental health (R-2 = .41, P < .01), whereas chronic family difficulties and parental warmth togeth er with the current bowel function variables, fecal and flatus contine nce function, best explained the variance in psychosocial outcome (R-2 = .77, P < .0001). Thus, the differences in treatment procedures and continence function between the HD and LARA groups may partially expla in differences in mental and psychosocial outcome. Conclusions: These findings suggest that anal dilatation and continence dysfunction may h ave negative impact on mental health and psychosocial functioning. Ind ications for and ways of performing the procedure of dilation, and the treatment of persistent incontinence problems, are questioned. Copyri ght (C) 1998 by W.B. Saunders Company.