Anal Stenosis and Anorectal Malformations

Question

My 3 month old daughter was diagnosed with anal stenosis after several bouts of stool infrequency, two of which lasted ten days without a bowel movement. We had to give her babylax to make her go. Her doctor wants her on a glycerin suppository, broken in half, two times a day. Is there any other treatment? Will she become dependent? He said it may take four months or more of this treatment. Could diluted juice help since she's almost four months old? Any input will be helpful, since I can't find information on her condition.
Kim Dennis - Nursing Student - Kenner, Louisiana

Dr. Greene's Answer

The gastrointestinal system is a long convoluted tube extending from the mouth, through the body, down to the anus. During development a portion of the tube may not form. This is called atresia (for example, in esophageal atresia, a section of the esophagus is missing). More commonly, a portion of the tube is too narrow. This is called stenosis. In pyloric stenosis for example, the pylorus (the valve at the outlet of the stomach) is too tight to permit stomach contents to pass through easily. Anorectal anomalies occur in about 1 of every 4,000 live births and include a wide spectrum of defects — some are minor and easily treated, some are complex and very difficult to manage.

Very early in development, the urinary tract and the embryonic rectum and anus are all part of the same structure. They separate by the seventh week of gestation. At the time of separation, the urinary tract already has an opening on the skin, but the anus is covered by a thin membrane. By eight weeks of gestation, the anal opening typically appears.

What is Anal Stenosis?

Anal stenosis refers to a narrowing of the anal opening, which makes it difficult for stool contents to pass through easily. Symptomatic children tend to be particularly colicky babies, because of the discomfort associated with the stool backing up. The stool may exit under pressure and look almost like a squirt gun. Treatment of this disorder usually involves gentle dilation of the anal opening. This is typically done twice a day. Every week a slightly larger lubricated dilator is passed to stretch the anus until it reaches normal size. In very mild cases, softening the stool may be sufficient until the anus grows sufficiently. Suppositories can make the child comfortable in the short run, but do run the risk of dependence. At around 4 months, apple or even prune juice may help the child to pass stool. Rarely, surgery is needed to insure an opening of adequate caliber. If this is an isolated anomaly, the prognosis is excellent.

Some children are born with no anal opening at all. This is called an imperforate anus. The rectum ends in a blind pouch, about 2 cm inside the perianal skin. Usually the sphincters are well developed. For these children, a colostomy is indicated during the newborn period, but once the final surgery corrects the defect, the prognosis is likewise excellent.

Who Gets Anal Stenosis?

The most frequent anorectal defect seen in boys is the recto-urethral fistula, or a communication between the rectum and the lower part of the urethra. These children also require a colostomy before the definitive repair period. The long term prognosis for normal urethral and rectal function is good.

The rectovesical fistula is a communication between the rectum and the bladder. These children usually also have poorly developed sacral bones and sphincters. The prognosis for normal bowel function is poor.

For all anorectal malformations, there is a very good correlation between the degree of development of the sacral bone with the final bowel and bladder functioning after correction. Children with an absent sacrum will almost certainly have permanent incontinence. Those with a well-developed sacrum will generally have an excellent outcome.

Based on the treatment your doctor has prescribed, I can only assume your daughter has a very mild case of anal stenosis. Although her condition is concerning to you now, in a few months you will probably be privileged to change many dirty diapers each week.

Last medical review on: March 17, 2011
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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19 Comments
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Recent Comments

Hello DR Green
My baby is 1month the doctor said that she have colicky there nothing I can do to help her but burp her before&after feeding, but my baby haven’t pass any poop from yesterday’…what can I do to help my baby???

I am a concerned Father of a 6 month old boy,he used to pass stools daily until he was 5 month old and then suddenly he started getting constipated and straining a lot while trying to poop.he is now on solids (some rice cereals ,fruits) we are adding prunes and apple juices in his diet daily but now he is going up to 4 days without passing stools,and have to depend on Suppository to start ,laxatives found to be ineffective and his Dr said this could he normal as he is not loosing weight and thriving .I am really worried ,can you help

Greetings. When starting solids, the stools do typically change (often firmer and smellier). Kids usually adjust to this fairly quickly. If difficulty passing stool happens again, it can be addressed at that time. But there may be no problem at all. When a parent is not quite comfortable about medical advice, I’m a fan of consulting another doctor, if available, and asking for their reasoning as well. Best, DrGreene.

Thank you Dr. for your prompt response regarding my Query,

As far as i Understand, According to Dr. 14 Size Dilator should easily pass on 5 month Baby but i thought a normal pinky size finger will not more than 13 size.

Dr. said as soon as they start solid, it will be again a difficulty on passing stool as my baby on feed till now.

beside this Dr. Said if he could able to make that size, we will look forward for Surgery.

i am little concern my baby should we need to dilate further or we can consult another dr.

Greetings. When starting solids, the stools do typically change (often firmer and smellier). Kids usually adjust to this fairly quickly. If difficulty passing stool happens again, it can be addressed at that time. But there may be no problem at all. When a parent is not quite comfortable about medical advice, I’m a fan of consulting another doctor, if available, and asking for their reasoning as well. Best, DrGreene.

I’m happy that your son’s constipation has resolved! Generally with anal stenosis, once babies are able to poop comfortably several times a day, no further dilation is needed. It’s better to treat based on the how the baby is functioning rather than treating based on an average normal number. And it’s better to be a little too tight than a little too loose.

If you get a chance, you may want to ask your doctor, though, why they suggested that. They may have a reason I don’t know about. Best, DrGreene

Thank you Dr. for your prompt response regarding my Query,

As far as i Understand, According to Dr. 14 Size Dilator should easily pass on 5 month Baby but i thought a normal pinky size finger will not more than 13 size.

Dr. said as soon as they start solid, it will be again a difficulty on passing stool as my baby on feed till now.

beside this Dr. Said if he could able to make that size, we will look forward for Surgery.

i am little concern my baby should we need to dilate further or we can consult another dr.

I am a concerned Father of my 5 month old boy,

when he was 4 month and so he was keeps scratching her for passing stool, i consult with the Dr. they perform dilation and inform us it a Nine size, it will be narrowing anal stenosis , he advice us dilation for 10 days, for size of 9 -10, 11-12, & 13-14.

we preform dilation for 10 days in which our problem of constipation & scratching was resolve, he is happy & doing poop 4 time a day.

aftar 10 days now we gone for follow up, dr. said 9-10 & 11 -12, 13 easily passing but 14 still get little narrowing, he advice us for dilation 6 week more.

i am little confuse, is it really need to dilate further, as our problem of constipation has been resolved.

please advise
She as a very hard time making stool she goes every three to four days with out going I usually

I’m happy that your son’s constipation has resolved! Generally with anal stenosis, once babies are able to poop comfortably several times a day, no further dilation is needed. It’s better to treat based on the how the baby is functioning rather than treating based on an average normal number. And it’s better to be a little too tight than a little too loose.

If you get a chance, you may want to ask your doctor, though, why they suggested that. They may have a reason I don’t know about. Best, DrGreene

Dear Dr Greene,
my name is Miroslav Krjak. I am from Slovak republic.I am a gynecologist.My grandson is now 9 months. He has a rectal stenosis. During the breastfeeding he have had no problem with stool.Problems started when he was 6 months old. GI ruled out Hirsprung s disesase but verified rectal stenosis. Modality of treatment is dilation of recti. It is very painful method for the baby but with small effect. Firs two days after dilation he is
pooping normal ant then with suppositoria.He has no problem with passing gas at all.Do You think this modality of the treatment should proceed or would You recommend a different treatment? Thank You for your time.
Miroslav Krjak,MD,PhD

How did things turn out for your little one? I’m in the process of going through the same things you have, I posted a comment on here with my baby’s problems

My son is almost 3 months old and has been having problems pooping since about 2 weeks old. He is fussy constantly won’t sleep unless being held and pushes constantly grunting and in pain. He is strictly breastfed and I have cut out all dairy from my diet. He has loose to soft stool and lots of gas that he can’t get out unless he is stimulated or if I hold his legs up and spread his anus open. We were sent to a GI specialist due to an X-ray showing trapped air but they said the X-ray was normal. The GI doc did a rectal exam very rough and acted like we were wasting her time bc our baby was too healthy to be there due to gaining weight. She ruled out Hirschsprung’s disease and said to just give him suppositories and lactulose. Well I just called her back the other day bc after her rectal exam he started pooping normal and passing gas with ease but it has been getting worse again and I suggested rectal stenosis but she insists it isn’t that she checked him but the way she rammed her finger in there she couldn’t have been able to tell bc she busted right through it. I have since started using my pinky lubed to dilate his little rectum for the past two days and he is a completely different baby, passing gas with ease and pooping normal without discomfort and he is sleeping peacefully not in my arms!!!

Dear Dr Greene,
my name is Miroslav Krjak. I am from Slovak republic.I am a gynecologist.My grandson is now 9 months. He has a rectal stenosis. During the breastfeeding he have had no problem with stool.Problems started when he was 6 months old. GI ruled out Hirsprung s disesase but verified rectal stenosis. Modality of treatment is dilation of recti. It is very painful method for the baby but with small effect. Firs two days after dilation he is
pooping normal ant then with suppositoria.He has no problem with passing gas at all.Do You think this modality of the treatment should proceed or would You recommend a different treatment? Thank You for your time.
Miroslav Krjak,MD,PhD

I was always though that Apple juice would constipated the child even more I do give her plum juice but she mostly spits it out I bought her the plumber smart from suns weet she still doesn’t like it
Thank you so much