Early reported rectal sensation predicts continence in anorectal anomalies

BackgroundStraining at stool is an automatic reflex in babies and implies the presence of rectal sensation. We hypothesised that early reported rectal sensation would predict future continence in children with anorectal anomalies.Aim of the studyThe aim of this study is to determine if early straining at stool was a useful predictor of future continence in infants born with high anorectal malformations.MethodsA retrospective case note review of prospectively collected clinical information was performed with institutional review board approval. All patients with intermediate/high anorectal malformation operated on by a single surgeon from 1984 to 2010 were included. After stoma closure, parents were asked:
- Do you see your baby straining to pass stool?
- Can you tell when your baby is about to pass stool?The responses were noted within the first year of stoma closure and then all patients were followed up until they were at least 3 ½ years old and continence could be assessed using the Krickenbeck outcome classification. Data were compared using Fisher's exact test and sensitivity, specificity and positive predictive value (PPV) were calculated.Main resultsForty-eight patients were included in the study. Sixteen (33%) were female (12 cloacal malformation, 3 rectovaginal fistula, 1 rectal atresia) and 32 (66%) were male (6 rectovesical fistulae, 22 rectourethral fistulae, 4 no fistula). Median follow-up was 9.7 years (range 3.5-17.9). Twenty-one children were noted by their parents to exhibit early straining at stool after stoma closure. Twenty of them achieved long term continence.The sensitivity of early straining as a predictor for long term continence was 77%, specificity 95% and positive predictive value 95%.ConclusionThe presence of early rectal sensation reported by parents is a good predictor of long term continence. This allows more informed discussion with families in the early years of life.