Imperforate Anus

Hey guys, in this lesson we are going to be talking about a birth defect called Imperforate Anus.
So, imperforate anus is really a spectrum of birth defects that all have to do with the incorrect formation of the anus. This could mean it isn’t fully developed or that there is a complete absence of an anus.

This obviously needs surgical repair and it usually requires multiple surgeries, including the placement of a temporary colostomy to allow stool to exit the body until they can complete the repair by surgically creating an anus for this child. A lot of times, after surgery the surgical wound may begin to close up so anal dilation has to be done to ensure that the new anus stays open to a size that is appropriate for the child.

In your assessment of a newborn, it’s important to just do a quick check to see if the child does actually have an anus. Then over the first 24 hours of life we need to be monitoring for the baby to have their first stool. These first stools a baby has are called meconium and the stool is very different than it is when they are being fed formula or breastmilk. Meconium is dark, almost black and very sticky. If a baby doesn’t pass meconium in the first 24 hours we need to figure out why. And one possible cause is what we are talking about in this lesson- imperforate anus.

The next thing to assess for is a fistula. A sign of a fistula or abnormal opening is having stool in the urine. So make sure you are looking at the all of the diapers to check for this. If there is a fistula this will complicate surgery and recovery.

Before surgery nurses will need to provide standard pre-op care like making the patient NPO and starting fluids.

After surgery you’ll need to provide wound care and likely restart feedings as soon as possible. Breast milk is preferred because there is a decreased risk for constipation. Parents will need a lot of education and support as they learn how to take care of a colostomy and perform tasks like anal dilation at home. This can all be incredibly overwhelming so we want to make sure parents are comfortable with all of this new care before we send them home.

For the most part there aren’t really many complications with imperforate anus, but one thing that can happen is a possible delay in toilet training. If that happens we need to help parents figure out how to help their child with bowel habit training and basically just reassure them that most kids with a history of imperforate anus are able to accomplish this task even if it’s a little bit later.

Your priority nursing concepts for a patient with imperforate anus are Gastrointestinal and liver metabolism, elimination, and human development.
Okay so let’s go over your major takeaway points for this lesson. So imperforate anus is an anal malformation where the anus is either missing or incomplete. Your nursing assessment is focused on looking for the baby to pass meconium in those first 24 hours after birth and also checking diapers for any signs of stool in the urine which would indicate there is a fistula. These babies need to have surgery and they may also need to have a colostomy placed. Anal dilation will need to be performed by the parents to make sure the anus stays open. These kids may have some difficulties with toilet training so make sure to provide support to parents if this is the case.

That's it for our lesson on Imperforate anus. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!