Caring for Your Child After Reconstructive Surgery for an Anal Malformation

Hi, my name is Olivia, and I am a nurse with the division of Colorectal and Pelvic reconstruction at Children's National Hospital. Today, I am going to talk to you about caring for your child after reconstructive surgery for an anal rectal malformation. Anal rectal malformations are birth defects that occur when the anus and rectum do not develop the way they should. This occurs in approximately 1 in every 5000 live births. The malformation can range from small to very complicated. To correct these malformations, a surgery called posterior sagittal anal recoplasty will be performed. We use the terms PSARP for short. During these procedures, a surgeon creates an anus to correct the location on your child's body. In more complex or complicated malformations, the procedure can also involve surgery of the vagina and urinary structures. The goal of this video is to make you feel confident and comfortable taking care of your child after they have had one of these procedures. To care for your child's surgical sites, you should not require any medical supplies. We want you to keep the stitches on your child's bottom clean and dry. If your child had cuts on their belly, he or she will have white strips of tape called Siri strips covering their cuts. This tape will fall off on its own in 7 to 14 days. Do not pull or remove the Steri-Strips, even if they start to look dirty or curl up on the ends. Leave them alone, and they will fall off when they are ready. Taking them off too soon can cause the skin to break open. If your child has an ostomy, you should go back. To the care that you were doing before the surgery. If your child is stooling or pooping from their anus or bottom, please be sure to watch our skincare educational video as your child will need special attention for their skin. Following either of these procedures, your child will have activity limits or certain things that they can't do. Your child should not be held in a straddle position for 3 months after surgery. A straddle position is when the child's legs are separated or opened wide. This happens when we carry our child on our hip or front or back carrier. Do not carry your child in a carrier or in any way that causes their legs to open wide. Often, toys will put a child into a straddle position and put pressure on the area of their body that was just operated on. This could be a rocking horse, a bike, an infant bouncing toy. Do not use these toys for. 3 months after surgery. Be gentle and careful you don't separate your child's legs when you place them in their car seat or change their diaper, or clean their bottom. Your child should not participate in rough play, lift anything heavy, or play contact sports for 2 weeks after surgery. In most cases, your child can begin to take a bath or swim 2 weeks after surgery. If your child has a Foley catheter draining their urine, they must wait until the catheter is removed before they can bathe or swim. Your child may go home with a Foley catheter after surgery to help drain their urine and help them heal. This catheter will need to be taken out or removed 1 to 2 weeks after they come home from the hospital. The balloon is what holds the catheter in place, so when you cut the balloon tube, the catheter will easily be able to be pulled out or will fall out on its own. Using the scissors provided to you in the hospital, cut the balloon port of the catheter at bedtime. This will empty the balloon. Should the catheter not come out easily, or if your child doesn't urinate or pee in 8 hours after you take it out, please call our team. After surgery, your child's stool pattern may change as they heal. Stools may be very loose and watery several times a day to coming out very thick and not coming out very often. Your child may be prescribed MiraLax and Or Senna upon discharge to make sure they are stooling every day. This also helps to soften the stool so hard stool is not passing through your child's new anal opening. The type of foods your child eats will be very important in bowel management. Our laxative food list will help stool to be softer and looser. Our constipating food list will help stool be thicker and harder. We have a great list that explains which foods are laxative and constipating, which can be found on our website. If your child is breastfed and stooling well, MiraLax and Orsenna may not be started until they begin eating salads and their stools start to thicken. If you experience any of the following problems, please call or email our medical team immediately. If your child has a fever of 101 °F or higher, the incision or surgical cut has a yellow or green liquid drainage. If the site edges are pulling open. If the catheter comes out of your child. Or if your child is vomiting and is not able to eat food or drink liquids. If you want more information, please visit the Colorectal Program's website. We have multiple videos and printed resources to help you care for your child. And don't forget, always check with your child's pediatrician or our medical team when caring for your child's medical needs.