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After the definitive correction of anorectal malformations (ARM), two different new diseases frequently occur: chronic constipation and stool incontinence. Chronic constipation is sometimes associated with smearing, staining, or overflow incontinence, which should not be confused with true incapability to retain stools due to an insufficient sphincter mechanism. Digital and electromanometric investigations under resting and squeezing conditions are very helpful for the differentiation. According to Holschneider et al., only 11.8% of the high-, 22.7% of intermediate-, and 63.3% of low-type malformations became completely continent without need of any additional help [1]. Total continence corresponds to the continence behavior of a healthy person who does not soil, does not have constipation, and can regularly and voluntarily have bowel movements. Another group of patients become continent with some aid, which means they need occasionally a light constipating diet or laxatives for the regulation of their stools. 23.5% of the patients with a high, 13.6% of children with an intermediate, and 22.7% of cases with a low type of imperforate anus behave this way. Taking these two groups of patients together, 35.3% of the high-, 36.3% of the intermediate-, and 86.3% of the low-type anal atresias became acceptably continent. In the literature this behavior is usually called "good continence".

The so-called "satisfactory results" in the literature involve two groups of patients: children who are chronically constipated and patients with a partially incompetent sphincter. However, the problems of the patients in both groups can be managed sufficiently by conservative means. Only the last small group in Holschneider's new classification [1], the "bad results" with complete therapy-resistant fecal incontinence need surgical therapy either due to untreat-able chronic constipation or complete incompetence of the anorectal sphincters. The surgical therapy for incurable constipation is described in Chap. 32 and consists of resection of a megarectum. In contrast, complete insufficiency of the anal sphincters needs strengthening, sometimes of the external anal sphincter muscles, by a continence-improving operation, which will be described in the Chap. 31. This very unsatisfactory group of children comprises 20.6% of the high-, 9.1% of the intermediate-, and 4.5% of the low-type malformations.

The largest group of patients is, as mentioned above, the so-called "satisfactory results." The continence behavior of these patients is, per se, not satisfactory at all. They consist of two different, postoperative newly appearing diseases, which have to be treated by different therapeutic means: chronic constipation and stool incontinence.

Fecally incontinent patients suffer from hypopla-sia of the muscle complex and an absence of smooth muscle fibers. For this group of patients, the diet must be constipative (e.g., bitter chocolate with 70% or more portion of cocoa, blueberries, bananas, apple pie, and carrot soup). Carrot pie however, may have a laxative effect due to its high amount of cellulose. Administration of activated carbon for medical use or loperamide, or the use of soft anal tampons after sufficient bowel cleaning may help.

Chronic constipation needs a totally different diet. The definition of the term constipation is difficult and imprecise. If bowel movements are only possible when the patient exerts the utmost pressure or after convulsive cramps, if there is a sensation that the bowel has not been completely emptied, if the stools are hard, if no bowel movements occur for a period of 3-4 days, or if an overflow soiling occurs, all of these occur rences are referred to as constipation [2,3]. Overflow soiling is the most common sign of chronic constipation in children after ARM repair. Rectal examination shows an impacted rectum that cannot be evacuated completely. The first therapeutic procedure described in Chap. 29 consists, therefore, of rectal washouts, as described in Chap. 31. After cleaning of as much colon as possible, either retro- or anterogradely, a laxative diet should be administered. This diet should take into account the underlying reasons for the constipation. Constipation can occur in an acute form (e.g., due to a change in diet when traveling, after febrile illnesses, after being bedridden for some time, because of local anal complaints, or after taking medication). They can occur, for example, if too little food is ingested, if insufficient roughage is consumed, if the amount of ingested liquids is insufficient, if the defecation stimulus is repressed, if the patient uses too many laxatives over longer periods, and/or if the patient has too little exercise. A medical examination will be necessary to clarify whether we are dealing with an acute and/or a chronic disorder, or if the constipation is the result of organic disease, (e.g., Hirschsprung's disease, dysgan-glionoses, or anal stenoses). The most frequent cause for chronic constipation in ARM are inborn motility disorders of the extra- or intramural nerve supply to the rectum, malformations of the rectal smooth muscle structure, or damage to the neuronal or vascular supply of the rectum during surgery. Whatever the reasons for the digestive complications, an optimal diet can have positive effect on constipation [3,4].

The best effect is achieved by a combination of different factors. These may include treatment of the underlying disease, a diet calculated to loosen the stools, drinks, bowel training, and exercise.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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