Long Term Bowel Function During Childhood

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Traditionally, the long-term results of low malformations are considered to be good in the great majority of patients (Table 28.1) [4,17,31,32,55]. The poor results have been considered to be related to neurological damage and mental retardation [56] or insufficient long-term care of the patients [3,32]. Recently, more critical and comprehensive analyses have demonstrated clearly a significant number of patients with functional aberrations, especially chronic constipation (Table 28.1). In the series of Yeung and Kiely [23], 15 of 32 children with a follow-up between 1 and 7 years had normal bowel function. Of the remaining 17 patients, all had constipation and 9 occasional or frequent soiling requiring treatment. Rintala et al. [57] used a scoring system to compare the bowel function of 40 children with low anomalies with that of healthy children. Only 52% of their patients had scores within the range of healthy children; constipation was found in 42% and soiling in 10% of the patients. Ong and Beasley [58] reported a follow-up of 70 patients with low ARM; of the 35 children under the age of 15, 9 were clean, 14 had occasional smearing, and 12 soiling. Laboure et al. [59] reported 27 male patients with 3-20 years follow-up; 48% of the patients had long-term problems related to constipation or soiling. Javid et al. [60] found, in their series of 44 girls with low imperforate anus, that 47% experienced at least occasional fecal incontinence. The median follow-up time in this series was 11 years.

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Constipation Prescription

Constipation Prescription

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