Does your baby have this rare condition? (Cloacal Malformation) Let's talk about it!

The joy a mother or father feels when they look at a newborn baby is indescribable. But sometimes, along with that joy, there are times when you feel a great sense of fear and shock. That's the feeling you get when the doctor comes and tells you that your child has a congenital problem. Cloacal Malformation is such an extremely rare condition, but one that shocks parents a lot. Today, we will talk about this simply, in a way that you can understand.

Simply put, what is Cloacal Malformation?

This is a very rare condition that only affects girls and is detected at birth. Normally, a girl's perineum should have three openings: the urethra, the vagina, and the anus.

However, a child with Cloacal Malformation does not have all three of these openings. Instead, there is only one opening . This condition belongs to a group of diseases called anorectal malformation.

Imagine, when a baby is developing in the womb, the baby's intestinal tract, genital tract, and urinary tract are all connected together as one unit. We call this the "cloaca." As the baby grows, this single unit gradually divides into three parts, forming three separate openings.

The treatment for this condition is surgery to create three separate openings instead of the single opening. This surgery is usually performed within the first year of the child's life.

Are there any varieties of this condition?

Yes, this condition can be seen with slight variations in each child. But what is common to all children is that they have one opening instead of three. This opening is connected internally to the "common channel" that we mentioned earlier. The length of this common channel determines the severity of the condition and what treatment the child needs. This channel can be anywhere from 1 to 10 centimeters long.

Let's explain this a little more.

How common is this situation?

This is a very rare condition, occurring in about one in 25,000 to 50,000 newborns.

What are the symptoms of this?

The main and most obvious feature is that only one opening is visible at birth instead of three.

In addition, these children may have other health problems.

• The clitoris takes the form of a male penis.
• An abnormal appearance in the anal area.
• More than one location in the vagina, uterus, or cervix.
• Other problems with the kidneys, ureters, or urinary system (urological problems).
• Heart or spinal problems.
• Other problems of the digestive system (Gastrointestinal problems).

Why is this happening? What is the reason?

Doctors have not yet found a specific cause for this. It is considered to be a random occurrence, or something that happens for no particular reason.

How to recognize this condition?

This situation can be identified in two ways.

1. Before the baby is born (during pregnancy)

Sometimes, this can be detected during an anomaly scan or ultrasound around 20 weeks of pregnancy. This is usually seen as the baby's vagina is swollen and filled with fluid. If this needs to be confirmed, an MRI scan can be done during pregnancy.

2. After the baby is born

This is often diagnosed after the baby is born when the pediatrician examines the baby. This condition can be recognized when there is one opening instead of three. The baby's belly may also be swollen. The doctor will then order several tests to see exactly what is going on inside the body.

• Ultrasound examination: Check the baby's kidneys, bladder, and spine.
• X-ray tests: Use special X-ray technology, such as fluoroscopy, to see how your child's urinary system works.
• Echocardiogram: A test to check for any problems with the heart.

How is it treated? Let's learn about surgery

The only treatment for this condition is surgery. The main goal of the surgery is to create three separate openings instead of the single opening, allowing the child to urinate and defecate normally and to control these things.

This treatment process usually occurs in several stages.

First stage: As soon as the baby is born

This is done within 48 hours of the baby's birth. The main goal here is to stabilize the baby's health and create a path for stool and urine to exit the body.

• Colostomy: In this procedure, the surgeon brings part of the child's large intestine to the surface of the skin on the abdomen and creates an opening. The stool then comes out of the opening and collects in a special bag attached to it. This is a temporary procedure until the child has major surgery.
• Catheterization: A catheter is inserted to help the child pass urine because the bladder is swollen or blocked.
• Vaginal drainage: If the child's vaginal drainage is swollen and fluid has accumulated, it can also be surgically drained.

Stage Two: Major Reconstructive Surgery

This major surgery is performed between 6 and 12 months of age, when the child's health is stable. This is where the three systems that are joined together are separated and three separate openings (anus, vagina, and urethra) are created.

• If the common fallopian tube is short (less than 4 cm), this surgery is relatively easy.
• If the common duct is long, the surgery becomes a little more complicated.

A pediatric surgeon and a pediatric urologist with specialized knowledge and experience in this area are essential for such surgeries.

Stage Three: Reversing the Colostomy

Once the child has fully recovered from the main surgery, the original colostomy is reversed. That is, the opening created in the abdomen is closed and stool is allowed to pass normally through the newly created anus.

What kind of future will my child have?

This is the biggest question on every parent's mind. Usually the results are very good.

• Children with a short common duct, meaning less complex ones, have a 90% chance of having completely normal urination and bowel control.
• Even children with a long common duct, i.e., complex conditions, have a 70% chance of having good control over urination and defecation.

Most children are able to defecate normally. However, some children may develop urinary incontinence, which is the involuntary loss of urine. Some children may need to have their bladder emptied several times a day using a catheter.

About sex life and pregnancy

Children with this condition can have a satisfying sex life when they grow up. Although pregnancy may be more difficult than normal, it does not mean that it is impossible to have children. If you are expecting a child in the future, you can seek medical advice about it. A C-section is often recommended when delivering the child.

What can I do as a parent?

This journey is challenging for both the child and you.

• Advocate for your child: Talk to your child's healthcare team regularly. Share any concerns or fears you have with them.
• Don't miss scheduled clinics and tests: After surgery, continued medical monitoring is necessary to ensure that the child's systems are functioning properly.
• Be aware of symptoms: If you notice any problems with urinary or bowel control as your child grows, tell your doctor right away.

Some questions to ask your doctor:

• How is this surgery performed? At what age is it performed?
• Will my child feel pain? Is he currently in pain?
• What should I expect during recovery after surgery?
• Will the child need more surgeries as he grows?
• Will I have problems with my rectum, urethra, or vagina in the future?
• Will my daughter be able to safely have a child in the future?

It's normal to feel heartbroken when you learn something like this. But remember, medical science is very advanced today. Surgery can successfully correct this condition, allowing your child to live a normal life. Your doctor and healthcare team will be a great support for you and your child on this journey.