Has your doctor ever told you or your baby about having surgery because of a problem with your anus or a congenital problem? You may have heard the word "anoplasty." This name can be a bit scary, but once you understand what it is and why it is done, your fears and doubts will disappear. Today, we will talk about this anoplasty surgery.
Simply put, what is anoplasty?
Anoplasty is a surgical procedure to repair or reconstruct your anus, the opening through which feces exit. The anus is the last part of our large intestine. It is a tube about 3-4 centimeters long, surrounded by circular muscles. We call these muscles sphincters . These are what help to expel feces. So, if there is a defect in the way this anus does not work properly, an anoplasty is performed to fix it. Some of these defects can be congenital. Others can develop later due to an accident or disease.
Why is it necessary to have this anoplasty surgery?
There are several main reasons for having an anoplasty. Let's see what they are. I will explain this to you with an easy-to-understand chart .
| Cause | Simple explanation |
|---|---|
| Anal Stenosis | This is most common in adults. The rectum becomes narrow due to scar tissue that forms in the rectum. This can happen as a side effect of a previous surgery or due to a long-term medical condition. When the rectum becomes narrow, stool does not stretch as well as it should, making it very painful to have a bowel movement. If other treatments fail to cure the condition, an anorectal surgery may be necessary. |
| Anorectal Malformations | These are conditions that occur in babies at birth. For example, an imperforate anus is a condition in which the baby's anus is not open or is blocked. Another is a perineal fistula . This is when the anus opens in the wrong place, not where it should be. This opening is usually very narrow, and it does not pass through the muscles that control bowel movements, so the baby cannot control bowel movements. |
When should a baby have this surgery?
If a newborn baby has a complication like this, it's only natural for you as a parent to be very upset. But remember, medical science has effective solutions for this. Some simple defects can be corrected with a simple anoplasty surgery within a few days of birth.
However, babies with more complex defects will need to undergo several surgeries. In such cases, the doctor will first perform a colostomy . This means that a temporary opening (stoma) is created in the baby's abdomen, allowing stool to pass through it. Then, when the baby is a little older, an anoplasty is performed at the appropriate time to properly repair the anus. After that, when the wounds heal, the original colostomy is removed and the baby can defecate normally through the anus.
How should I prepare before surgery?
If you are an adult, your surgeon will tell you to completely clean out your bowels before surgery. This involves giving you a special drink called a bowel prep . You drink this the day before surgery. This will make you need to go to the bathroom more often and will empty your bowels completely.
You will be asked to follow a special diet for a few days before taking this drink. Typically, you will be advised to eat a low-fiber diet for about two days and drink only clear liquids on the last day. Your doctor will explain all of this to you clearly.
What happens during the surgery?
The main goal of an anoplasty is to recreate a functioning anus. The steps your surgeon will follow may vary depending on your condition.
Typically, you are put under general anesthesia and turned over on your stomach. Surgeons first use an electrical stimulator to find the areas where the muscles in your rectum contract. This allows them to map out exactly where your rectum should be and where the muscles are located.
- If the anus is narrowed (Anal Stenosis): This involves removing the scar tissue that caused the narrowing. Then the anus can open up again. However, when the scar is removed, a small hole is left inside. To close it, the surgeon takes a small piece of skin (skin flap) from your buttocks (the skin around the anus), closes the hole, and stitches it closed.
- For a baby with anorectal malformations: If the baby's anus is missing or in the wrong place, the surgeon will need to create a new anus. This new anus must pass through the anal sphincter muscles at the end of the baby's large intestine and open in the right place. If there are fistulas that open in the wrong places, they will also need to be closed.
What happens after the surgery? What complications can occur?
Depending on the nature of the surgery, you may go home the same day or stay in the hospital for a few days. The doctor will monitor you closely until your wounds heal.
The most important thing is to do anal dilations as directed by your doctor while the wound is healing. This involves inserting a special device (dilator) into the anus daily to widen it a little. This is done to prevent the newly created anus from narrowing again (stenosis) as it heals.
As with any surgery, there is a small chance that anoplasty surgery may cause some risks or complications. Let's be aware of that as well.
| Type of complication | Description |
|---|---|
| Short-term Complications | |
| Infection | If the wound becomes infected while it is healing, it may take longer to heal. Your medical team will teach you how to prevent this. |
| Blood clot (Hematoma) | Blood collects inside the wound and forms a clot. Applying ice, pressure, and a bandage will help. You may also need to do a little something to remove the blood. |
| Difficulty urinating (Urinary Retention) | Some people have difficulty urinating after surgery. This can be temporarily relieved with medication or, if necessary, a catheter. |
| Constipation | This can happen to people who have had constipation before. The doctor will give you the necessary medication for that too. |
| Long-term Complications | |
| Inability to control stool (Fecal Incontinence) | Surgery can affect the muscles or nerves that control bowel movements. Some babies with birth defects may lose the necessary nerves and muscles. Over time, some will gain control, while others will lose it. Your doctor will talk to you about this and what can be done about it. |
| Stenosis | If the dilation is not done properly during the healing process, the anus may become narrow again. Therefore, it is essential to do it exactly as the doctor tells you. |
| Diaper Rash | When babies start to defecate through their newly formed anus, they can develop a severe rash. This is because the skin has not been exposed to feces before. This can be controlled by applying special ointments. |
How is the recovery time?
It usually takes between 4 and 8 weeks for the wounds to heal completely. It is normal to bleed a little during the daily dilation, so don't worry about it. It is not very painful. Your doctor will give you the necessary medication to control the pain. You will also be asked to follow a special diet during this time.
For babies who have had a colostomy, the final surgery to remove the colostomy can be performed once the rectum has completely healed.
Narrowing of the anus or congenital defects are rare conditions, but if they do occur, it can be reassuring to know that successful results can be achieved with surgeries like anoplasty.
Take-Home Message
- Anoplasty is a specialized and highly successful surgery performed to correct narrowing and congenital defects of the anus.
- It is very important to follow your doctor's instructions carefully during your recovery after surgery, especially when it comes to dilation.
- If you are the parent of a baby born with this type of birth defect, you are not alone. Work closely with your surgical team and get the support you need.
- If you have any questions, fears, or doubts about this, please discuss them with your doctor without hesitation.
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