Anorectal Malformation Surgery
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Surgery Referrals
At Rady Children’s Health, Orange County, we understand that an anorectal malformation diagnosis can feel overwhelming. Our multidisciplinary team is here to guide and support your family every step of the way, providing expert care and helping you feel confident in the decisions ahead.
What anorectal malformations require surgery?
Most anorectal malformations require surgical treatment. The specific operation depends on the type of malformation, where the rectum ends, and whether it is connected to nearby structures such as the urinary tract. Your child’s care team will recommend the safest and most appropriate surgical approach based on their individual anatomy.
Pediatric procedures for anorectal malformations at Rady Children’s Health
Because every child has unique needs, your child’s anatomy, symptoms, and overall health will help shape the treatment plan. Our team will partner with your family to recommend the approach that is safest and best suited for your child.
This surgery is called posterior sagittal anorectoplasty (PSARP), also called the Peña Procedure. In this operation, your baby’s rectum will be repositioned in the correct location and an anal opening will be created. This surgery is done under general anesthesia and is performed in the first days of life for babies who are full-term and healthy. A few weeks after surgery, your doctor will ask you to do anal dilations, an after-care procedure to help keep the new opening from tightening up or scarring closed.
A colostomy is a procedure that brings the large intestine to an opening in the abdomen. It is usually temporary and does not affect your child’s ability to eat. It may be recommended before repair for babies who are premature, very small, have other medical conditions, or have a more complex anorectal malformation. Your care team will provide education and support for colostomy care at home.
In some children, a temporary colostomy is recommended before definitive repair. During this procedure, a portion of the large intestine is brought through a small opening in the abdominal wall, usually on the lower left side of the abdomen. This creates a stoma, which allows stool to leave the body safely and be collected in a pouch.
The bowel may also be divided to create a mucous fistula, a second small opening that allows mucus from the lower portion of the intestine to drain. The mucous fistula also plays an important role in planning future surgery.
Before the repair, doctors perform a specialized imaging study called a pressure-augmented distal colostogram. This study helps the surgical team understand the child’s anatomy, including the position of the rectum and whether there is a connection between the bowel and urinary tract.
After the anorectal repair, the colostomy is typically maintained for approximately 2 to 3 months while the new anus heals. Once healing is complete, a second procedure is performed to close the colostomy and restore the normal pathway for stool.
After surgery to repair an anorectal malformation (ARM), the new anal opening can sometimes become narrower as it heals. Anal dilations are gentle stretching exercises that may be recommended to help keep the opening at an appropriate size and reduce the risk of narrowing (stenosis).
If dilations are needed, your surgical team will provide detailed instructions. Many parents find the dilation process emotionally challenging, and these feelings are completely understandable. As a result, some colorectal surgeons now take a more individualized approach to care.
Depending on your child’s anatomy, surgery, and healing progress, your surgeon may recommend routine dilations, less frequent dilations, or close observation without dilations. Together, you and your care team will determine the approach that best supports both your child’s physical healing and emotional well-being.
What to expect after anorectal malformation surgery
Surgery can feel overwhelming — for children and for parents. That’s why CHOC focuses on more than just the procedure. We deliver safe, advanced surgical care in a setting built for kids, with expert teams who support your entire family throughout the process. From your first consultation to recovery at home, our goal is to ensure you feel informed, confident and supported.
The goal of bowel management is to help your child stay clean, comfortable, and healthy. Some children with anorectal malformations (ARMs) or Hirschsprung disease may have difficulty controlling bowel movements or may experience constipation. A personalized bowel management plan can help support regular bowel habits and improve quality of life.
Many children can achieve toilet training at the usual age, and our goal is for every child to achieve the best possible bowel control. For some children with more complex anorectal malformations, continence may be more challenging. Your surgeon and gastroenterologist will help you understand what to expect and develop a plan tailored to your child’s needs.
Diet is often the first step. Your baby can eat soon after surgery. A few weeks after surgery, stools are passed less often and are more solid. Certain foods can make stool firmer or looser, and your care team may recommend increasing fiber, adjusting fluid intake, or limiting foods that contribute to loose stools. Your child’s health care provider may recommend a high-fiber diet to help with constipation. This includes fruits, vegetables, juices, whole-wheat grains and cereals, and beans. Small dietary changes can sometimes make a meaningful difference on their own or alongside other treatments.
Some children can manage their bowel movements with medications taken by mouth. Your child’s care team may recommend stool softeners such as polyethylene glycol, magnesium supplements, lactulose and/or stimulant laxatives such as senna or bisacodyl, depending on your child’s needs. These medications help soften the stool, prevent constipation, and allow the colon to empty more regularly.
Some children need extra help emptying their colon. A transanal enema uses fluid placed into the rectum through a small tube or catheter to help the colon empty stool. Enemas are usually given once a day and can help children stay clean between bowel movements. Special additives may be included to improve effectiveness, and a variety of catheter and delivery systems are available.
For some children, bowel management can be made easier with an antegrade enema, delivered through a small surgically created opening on the abdomen. This may be done using the appendix (appendicostomy/MACE), a surgically created channel, or a cecostomy button placed into the colon. Enema fluid is administered through this opening, flushing stool through the colon and out through the rectum. These options can simplify bowel care for families and may help older children become more independent in managing their bowel routines.
Recovery from anorectal malformation surgery
Therapy can be an important part of recovery and long-term bowel management for children with anorectal malformations. Our team offers personalized treatment options designed to improve function, support independence, and help children thrive at every stage of development.
- Pelvic floor therapy helps children strengthen and improve coordination of the muscles used for bowel and bladder control. It can be especially helpful for children with anorectal malformations, Hirschsprung disease, or ongoing challenges with constipation or soiling. Pelvic floor therapy is typically recommended for children who can follow instructions, often around age 5 or older. Your child’s care team can help determine whether this therapy may be beneficial.
- Core-strengthening focuses on the pelvic floor, abdominal, and back muscles, which work together to support bowel and bladder function. Exercises are tailored to each child’s age and abilities and can often be practiced at home to help build strength, stability, and coordination.
- Biofeedback uses sensors and a computer screen to help children learn how to properly squeeze and relax their pelvic floor muscles. By making muscle activity visible, children can improve bowel control and develop healthy bathroom habits. The exercises are painless and are guided by a specially trained therapist.
If additional support is needed, your care team may recommend referral to a specialized bowel management program. For more information about care after anorectal malformation surgery, visit our aftercare guide.
Preparing your child for colorectal center visits
Most children with an anorectal malformation have surgery early in life to help support healthy bowel function. As they grow, regular follow-up visits can help ensure they stay healthy and comfortable. During these appointments, the care team may ask about bowel habits, diet, and any concerns, and may perform a brief exam. These visits are also a chance for families to ask questions and learn more about their child’s care.
To help prepare for a colorectal visit, talk with your child in a calm, age-appropriate way about why they’re seeing the doctor. Let them know the doctor may ask questions about eating habits and bathroom routines and may do a brief exam of their tummy and bottom. Reassure your child that these conversations are a normal part of care and encourage them to ask questions if they have any concerns. Bringing a favorite comfort item, book, or activity can help them feel more at ease. If possible, one caregiver can focus on supporting the child while another speaks with the care team. A little extra praise or a small reward after the visit can also help make future appointments feel easier.
Caring for you and your child’s mental wellbeing after anorectal malformation repair
Having a child with an anorectal malformation (ARM) can be an overwhelming and stressful experience for both patients and caregivers. It is important to recognize that these feelings are common and valid. Seeking support, whether through counseling, support groups like the Pull-Thru Network, or speaking openly with your child’s healthcare team, can help patients and families process these experiences and build healthy coping strategies over time.
You are never alone. At Rady Children’s, we are here to help. Learn more about how to support your child through difficult diagnosis.
The Rady Children’s Health Orange County Colorectal and Urogenital Center provides all of the required specialists and support services to care for all forms of Anorectal Malformations.
We can be contacted at [email protected] or by calling (714)-509-4099