Imperforate Anus, Female, Total

Care After

If your child just had surgery for imperforate anus, it was done to correct a problem she was born with. Her anus (the opening where bowel movements leave the body) did not form correctly. The goal of surgery to correct this is to create a safe way for bowel movements to leave the body. Sometimes more than one operation is needed.

The type of surgery depends on the severity of the condition:

  • If her condition was mild, it is possible that only 1 operation was required. This surgery is called a perineal anoplasty. A new anus is created. The bottom section of the large intestine (rectum) is stitched to the inside of the new opening. Any other openings (fistulas) where bowel movements were coming out are stitched closed.

  • If her condition was more severe, an initial surgery may have been done as a temporary fix. This is a colostomy. This surgery creates a new opening in the belly (abdomen) for bowel movements. The bowel movements will drain into a bag. This stays in place until a second surgery is done to create an anal opening. This second surgery is called a posterior sagittal anorectoplasty. This surgery repairs the rectum and creates an anal opening. A third surgery will be needed in about 3 to 6 months. This is to undo the colostomy.

AFTER PROCEDURE

  • Your child will stay in a recovery area until the anesthesia has worn off. Her blood pressure and heart rate will be checked often. Usually, you will be able to hold her once she starts to wake up. Next, she will be moved to an intensive care area or to a regular hospital room. Most children stay in the hospital for at least a few days after surgery. This varies based on the child's age and the type of surgery.

  • A cream may be put on the area around the new anus. This is to protect it from diaper rash, which often develops. The rash is caused by frequent bowel movements.

  • Your child will be able to drink during recovery.

  • Breast milk or formula can be given to young infants.

  • Older children will start with liquids only. In time, soft foods can be added.

  • Your child will be getting pain medicine for awhile. Let her caregivers know if you think she is in pain.

  • Your child also will be given stool softeners. These may need to be taken for a month or more.

  • A hospital caregiver will show you how to keep your child from playing with the incision.

  • If your child has a colostomy, you will be shown how to care for it.

  • Before your child goes home, be sure to ask her caregiver about her diet. This is especially important for an older child. Your caregiver will tell you the things she should or should not eat. The goal is to keep bowel movements soft.

  • Ask about activity. Your caregiver will tell you the things your child should or should not do while she recovers.

HOME CARE INSTRUCTIONS

  • Make sure your child takes any medication that her surgeon prescribes. Follow the directions carefully. She should take all of the medication.

  • Do not get the wound wet for the first few days after surgery (or until the surgeon tells you it is OK).

  • If your child has a severe diaper rash, use whatever cream her caregivers suggests. This will need to be put on the area around the new anus several times a day.

  • If your child had a colostomy, preventing infection is very important:

  • Keep the skin around the opening (the stoma) clean and free of germs.

  • Empty the bag when it is less than half full. Before a nap is a good time to do this.

  • Replace the bag every 2 or 3 days. There are different types of bags. You may need to try out a few before you find the one that works best for you.

  • If the bag leaks, replace it right away.

  • Do not expect your child to be able to control her bowel movements. Stool will come out of the stoma whenever it needs to.

  • She may have gas. It will go into the pouch. Do not poke holes in the pouch to release the gas.

  • The stoma should look moist and pink. It may be swollen after surgery. This may last for a few months.

  • If your child had a perineal anoplasty or a posterior sagittal anorectoplasty:

  • You may need to stretch (dilate) the anus. A special tool is used to do this. Often it needs to be done twice a day. This helps it become strong as it grows. Ask your child's surgeon or caregiver how this should be done. Follow their directions very carefully.

  • Special help might be needed when it is time for potty training. Ask your child's caregivers for suggestions.

SEEK MEDICAL CARE IF:

  • You notice blood or fluid leaking from the wound.

  • The wound becomes red or swollen.

  • Your child continues to have pain or trouble with a bowel movement.

  • Your child has trouble passing urine.

  • Your child vomits for more than 2 days after the surgery.

  • She seems to be in pain, even after pain medication is given.

  • Your child stops gaining weight and growing.

  • Your child has an oral temperature above 102° F (38.9° C).

  • Your baby is older than 3 months with a rectal temperature of 100.5° F (38.1° C) or higher for more than 1 day.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child cannot have a bowel movement.

  • Your child's belly becomes hard or swollen.

  • Your child stops eating.

  • Your child seems dehydrated (lacking fluids). She may:

  • Seem more tired than usual.

  • Have sunken eyes.

  • Have dry lips.

  • Not have tears when she cries.

  • The stoma turns a dark color instead of a healthy pink.

  • Your child has an oral temperature above 102° F (38.9° C), not controlled by medicine.

  • Your baby is older than 3 months with a rectal temperature of 102° F (38.9° C) or higher.

  • Your baby is 3 months old or younger with a rectal temperature of 100.4° F (38° C) or higher.