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Unexpected results of a nationwide, treatment-independent assessment of fecal incontinence in patients with anorectal anomalies

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Abstract

Purpose

To determine the anorectal function in patients with anorectal malformations (ARM) in order to facilitate patient counseling and follow-up.

Methods

Data were collected by the German network for urorectal malformations (CURE-Net) according to the International Krickenbeck consensus. Questionnaires on bowel function and a defecation protocol were completed by the families/patients. The clinical findings were assessed from the patients’ clinical records.

Results

Two hundred and ninety-seven patients with ARM were assessed, 175 patients gave complete data on continence, 52 of them were excluded due to mental retardation, age, and earlier type of pullthrough. Complete continence was found in 27 %, perineal fistula in 40 %, rectourethral/vesical in 10 %, vestibular in 24 %, cloaca in 0 %. Krickenbeck grade 1 soiling: 42 %, grade 2 and 3: 31 %. Forty-nine percent of the incontinent patients practiced bowel management, reaching continence in 19 %. The statement of constipation (67 %) was validated with the last clinical findings, showing coprostasis in 46 %, “Not suffering constipation” was confirmed in 61 % and falsified in 29 %.

Conclusion

ARM patients in Germany, as assessed by independent researchers, show a high rate of fecal incontinence and insufficiently treated constipation. Parents should be counseled accordingly and motivated to engage in consequent follow-up. Intensified efforts in the conservative treatment of constipation and fecal incontinence are crucial to improvement.

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Acknowledgments

E. Schmiedeke, N. Zwink, N. Schwarzer, E. Bartels, D. Schmidt, S. Grasshoff-Derr, S. Holland-Cunz, S. Hosie, S. Maerzheuser, H. Reutter, C. Lorenz and E. Jenetzky are members of the “Network for the Systematic Investigation of the Molecular Causes, Clinical Implications, and Psychosocial Outcome of Congenital Uro-Rectal Malformations (CURE-Net)” which was initiated 2009–2012 by a research grant (no. 01GM08107) from the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF).

Conflict of interest

There is no conflict of interests.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery and Urology, Centre for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany

    Eberhard Schmiedeke & Christian Lorenz

  2. Institute of Human Genetics, University of Bonn, Bonn, Germany

    Enrika Bartels, Dominik Schmidt & Heiko Reutter

  3. Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany

    Dominik Schmidt

  4. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany

    Nadine Zwink & Ekkehart Jenetzky

  5. Department of Pediatric Surgery, Klinikum Schwabing, Technical University Munich, Munich, Germany

    Stuart Hosie

  6. Department of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Stefan Holland-Cunz

  7. Unit of Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany

    Sabine Grasshoff-Derr

  8. Self-Support Organisation “Anorectal Malformation” SoMA e.V., Munich, Germany

    Nicole Schwarzer & Ekkehart Jenetzky

  9. Department of Pediatric Surgery, Charité-University Medicine Berlin, Berlin, Germany

    Stefanie Maerzheuser

  10. Department of Neonatology, University of Bonn, Bonn, Germany

    Heiko Reutter

  11. Pediatric Radiology Department of Radiology and Nuclear Medicine, Klinikum Bremen-Mitte, Bremen, Germany

    Karsten Jablonka

  12. Clinic for Pediatric Surgery and Pediatric Urology, St. Jürgen-Str.1, 28177, Bremen, Germany

    Eberhard Schmiedeke

Authors
  1. Eberhard Schmiedeke
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  2. Nadine Zwink
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  3. Nicole Schwarzer
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  4. Enrika Bartels
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  5. Dominik Schmidt
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  6. Sabine Grasshoff-Derr
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  7. Stefan Holland-Cunz
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  8. Stuart Hosie
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  9. Karsten Jablonka
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  10. Stefanie Maerzheuser
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  11. Heiko Reutter
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  12. Christian Lorenz
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  13. Ekkehart Jenetzky
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Corresponding author

Correspondence to Eberhard Schmiedeke.

Additional information

Further participants in the CURE-Net Study: Dr. A. Schmedding (Department of Pediatric Surgery, Bürgerhospital Frankfurt a. M., Frankfurt, Germany). Dr. H. Bachour (Department of Pediatric Surgery, University of Bonn, Bonn, Germany). Prof. Dr. Dr. T.M. Boemers (Department of Pediatric Surgery and Urology, Children’s Hospital of Cologne, Cologne, Germany). Dr. M. Palta (Department of Pediatric Surgery, Evangelisches Krankenhaus Hamm, Hamm, Germany). Dr. C. Haßelbeck (Department of Pediatric Surgery, St. Hedwig Hospital Barmherzige Brüder, Regensburg, Germany). Dr. F. Kosch (Department of Pediatric Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany). Drs. N. Spychalski, M. Schäfer (Department of Pediatric Surgery and Urology, Cnopf’sche Kinderklinik, Nürnberg, Germany).

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Schmiedeke, E., Zwink, N., Schwarzer, N. et al. Unexpected results of a nationwide, treatment-independent assessment of fecal incontinence in patients with anorectal anomalies. Pediatr Surg Int 28, 825–830 (2012). https://doi.org/10.1007/s00383-012-3127-1

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  • DOI: https://doi.org/10.1007/s00383-012-3127-1

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