Related Experiment Video
Updated: Mar 30, 2026
In vitro Functional Characterization of Mouse Colorectal Afferent Endings
Published on: January 21, 2015
Early reported rectal sensation predicts continence in anorectal anomalies
Clare Skerritt1, Athanasios Tyraskis1, Clare Rees1
1Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK.
Insights
Early straining at stool in infants with anorectal malformations is a strong predictor of future continence. This finding helps parents understand their child's long-term prognosis and aids in early life discussions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Pediatrics
Background:
- Straining at stool in infants is an automatic reflex indicating rectal sensation.
- Rectal sensation is hypothesized to predict future continence in children with anorectal anomalies.
Purpose of the Study:
- To determine if early straining at stool predicts future continence in infants with high anorectal malformations.
Main Methods:
- Retrospective review of prospectively collected data from 48 patients with intermediate/high anorectal malformation.
- Parents reported on early straining at stool within one year of stoma closure.
- Patients were followed until at least 3.5 years old for continence assessment using the Krickenbeck outcome classification.
Main Results:
- Twenty-one of 48 patients exhibited early straining at stool.
- Twenty of these 21 patients achieved long-term continence.
- Early straining demonstrated 77% sensitivity, 95% specificity, and 95% positive predictive value for predicting continence.
Conclusions:
- Parent-reported early rectal sensation is a significant predictor of long-term continence in children with anorectal malformations.
- This finding facilitates more informed discussions with families regarding prognosis.
Background:
Straining at stool is an automatic reflex in babies and implies the presence of rectal sensation. We hypothesised that early reported rectal sensation would predict future continence in children with anorectal anomalies.
Aim Of The Study:
The aim of this study is to determine if early straining at stool was a useful predictor of future continence in infants born with high anorectal malformations.
Methods:
A retrospective case note review of prospectively collected clinical information was performed with institutional review board approval. All patients with intermediate/high anorectal malformation operated on by a single surgeon from 1984 to 2010 were included. After stoma closure, parents were asked: The responses were noted within the first year of stoma closure and then all patients were followed up until they were at least 3 ½years old and continence could be assessed using the Krickenbeck outcome classification. Data were compared using Fisher's exact test and sensitivity, specificity and positive predictive value (PPV) were calculated.
Main Results:
Forty-eight patients were included in the study. Sixteen (33%) were female (12 cloacal malformation, 3 rectovaginal fistula, 1 rectal atresia) and 32 (66%) were male (6 rectovesical fistulae, 22 rectourethral fistulae, 4 no fistula). Median follow-up was 9.7years (range 3.5-17.9). Twenty-one children were noted by their parents to exhibit early straining at stool after stoma closure. Twenty of them achieved long term continence. The sensitivity of early straining as a predictor for long term continence was 77%, specificity 95% and positive predictive value 95%.
Conclusion:
The presence of early rectal sensation reported by parents is a good predictor of long term continence. This allows more informed discussion with families in the early years of life.
Related Concept Videos
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Nursing Assessment of the Genitourinary System II: Inspection and Palpation