Colonic motility in children with repaired imperforate anus

Following surgical correction of imperforate anus, voluntary bowel control is frequently poor because of abnormal anorectal function. Using colonic ma nometry we investigated the role of colonic motility in the pathogenesis of fecal soiling in children following imperforate anus repair. Thirteen chil dren with repaired imperforate anus and fecal soiling underwent motility te sting 2-12 years after anoplasty. All had fecal incontinence unresponsive t o conventional medical treatment. Colonic manometry was performed using wat er-perfused catheters. Anorectal manometry was undertaken in 10 patients. M otility study results, treatment and outcomes were compared. All patients h ad high-amplitude propagating contractions (HAPCs) with an average of 80% p ropagation into the neorectum, There was no correlation between HAPC number or morphology and any variable. Internal anal sphincter resting pressure w as low in 6/10 patients. Relaxation of the internal anal sphincter was pres ent in 6/10 children. Only 1 of 5 patients able to cooperate was capable of generating a normal maximal squeeze pressure. Therapeutic regimens were ch anged in 11 patients with clinical improvement in five, Fecal soiling in pa tients with repaired imperforate anus is a multifactorial problem including propagation of excessive numbers of HAPCs into the neorectum as well as in ternal anal sphincter dysfunction, Colonic manometry in conjunction with an orectal manometry aids in the understanding of the pathophysiology of fecal soiling and guides clinical management in children with repaired imperfora te anus.