Longitudinal study of bowel function in children with anorectal malformations

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Urology

Background:

• Anorectal malformations (ARM) present complex challenges in pediatric care.
• Long-term bowel function outcomes in ARM patients require continued investigation.
• Spinal cord pathology and neurogenic bladder dysfunction (NBD) can significantly affect ARM patient prognosis.

Purpose of the Study:

• To longitudinally track changes in bowel function in children with ARM.
• To identify predictors influencing bowel functional outcomes in this population.
• To compare outcomes in ARM patients with and without spinal cord pathology and NBD.

Main Methods:

• A cohort of 41 children with ARM (excluding perineal fistula) was followed.
• Bowel function was assessed at ages 5, 10, and 15 years via questionnaires and 3-week diaries.
• Data included bowel movement frequency, fecal leakage, soiling, enema use, and diaper use, compared to 52 healthy controls.

Main Results:

• Bowel function, including continence, soiling, and constipation, improved with age in ARM patients with normal spinal cords.
• Girls achieved continence earlier than boys. Boys with spinal cord malformations, NBD, and specific fistulas had the poorest outcomes.
• Psychosocial comorbidities and megarectosigmoid were identified as risk factors.

Conclusions:

• ARM patients demonstrate progressive improvement in bowel function throughout childhood and adolescence.
• However, their functional levels remain below those of healthy children.
• NBD, spinal cord malformations, sacral malformations, and prostatic/bladder neck fistula (PRF/BNF) are negative predictors of bowel function.