Surgery and Disorders of Defecation in Children

When a new baby is born, we assume that he or she will spend most of the first few months of life engaged in a small number of basic activities: sleeping, feeding, peeing, and pooping. The passage of waste is a basic function of all living organisms, which is so ingrained and routine that most of us do not even think twice about it. In particular, defecation (the passage of stool) is considered to be a normal part of being a human being.

Unfortunately, there are some children who may have difficulties with the normal passage of stool, either because of physical or physiological abnormalities. In severe cases, failure to pass feces may result in intestinal obstruction, which can be fatal if it is not recognized and treated. In milder cases, these disorders may become the source of embarrassment, discomfort, and stress due to lack of social acceptance.

Normal defecation requires several processes to work properly. Most defecatory problems arise from abnormalities of one or more of these mechanisms.

Children may suffer from a number of birth defects that interfere with defecation. In addition, the fact that control of defecation is a normal developmental process during childhood makes the diagnosis and management of these problems particularly difficult and challenging.

The inability to defecate in children is usually due either to a problem with formation of the anus (anorectal malformations) or with the inability of the colon to push the stool from one end to the other (Hirschsprung's disease and other motility disorders).

The inability to control the passage of stool may be due to inadequate muscle, impaired sensation, or severe constipation with "overflow" incontinence.

Although the majority of children with defecatory disorders can be successfully treated with medical, dietary, and behavioral approaches, a surgeon can sometimes be extremely helpful or even provide a cure for the problem.

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