Incontinence and constipation after low anorectal malformations in a boy

Background: Low anorectal malformations are considered to be a benign type of anorectal malformations. Their treatment is simple in the neonatal perio d and gives good results as far continence is concerned. Methods: We studied a group of 55 boys with low anorectal malformations whi ch had been surgically treated between the 1st January 1975 and the 31st De cember 1992. We studied the initial treatment and the associated anomalies. 5 patients have died. 27 were seen for an interview and a clinical examina tion. Extra investigations (anorectal manometry or electromyography of exte rnal sphincter) were only offered to consenting patients with an ongoing pr oblem. Results: 3 to 20 years had passed since their operations. Associated anomal ies had been found in 11 children. The initial treatment was a perineal pro cedure in 20 cases and a colostomy In 8 cases. Dilatations were carried out on 11 children. Faecal and urinary continence had been acquired before 30 months of age. 13 children (48%) had problems of soiling and/or chronic con stipation. There was no difference between these children and the 14 contin ent ones regarding the type of malformation, the initial treatment and the follow-up. Anorectal manometry (performed on 9 cases) showed 4 anorectal dy ssynergies. It was normal in 3 cases. The Recto Anal Inhibitory Reflex was always present. Conclusion: Problems of continence are not rare in the evolution of low ano rectal malformations. We suggest therefore a longterm clinical follow-up fo r those children, with one anorectal manometry control being performed afte r continence is acquired.