An anorectal malformation is a condition present at birth that affects how the anus (the opening where stool leaves the body) or rectum (the last part of the large intestine) develops. Some children are born without an anal opening, while others may have an opening that is too narrow or located in a different place. Anorectal malformations can also occur with differences in the urinary, reproductive, spinal or other body systems.

Anorectal malformations can vary widely. They may include:

• An anal opening that is missing, too narrow or in an unusual position
• A rectum that does not connect normally to the anus
• A fistula, an abnormal connection between the rectum and another part of the body, such as the urinary or reproductive system
• More complex differences involving the bowel and other pelvic organs

Symptoms

Anorectal malformations are usually identified at birth. Depending on the type of malformation, your child may have:

• No visible anal opening
• An anal opening in an unusual location
• Difficulty passing stool
• A swollen belly
• Stool passing through another opening

As children grow, many experience constipation or difficulty controlling bowel movements.

How we evaluate your child

Our colorectal specialists examine your child and may use imaging to understand how the anus, rectum and surrounding organs developed. Because anorectal malformations can occur with differences in other parts of the body, we will evaluate the spine, kidneys, urinary system and other organs.

Treatments

Treatment depends on the type of anorectal malformation and your child’s anatomy. Many children need surgery to create or reconstruct an anal opening and connect the rectum so stool can leave the body normally.

After surgery, some children need ongoing support to manage constipation or bowel control. Treatment may include medications, nutrition support or a personalized bowel management plan. We continue to monitor your child as they grow and adjust their care as their needs change.

Chronic constipation is ongoing difficulty passing stool or having infrequent bowel movements that lasts for several weeks or longer. Constipation is common in children, but when it becomes severe, continues despite treatment or causes frequent stool accidents, specialized evaluation may be needed.

Chronic constipation can develop for many reasons. Children may begin holding stool after having a painful bowel movement, which can lead to a cycle of harder stools and more discomfort. Other factors may include:

• Not getting enough fiber or fluids
• Changes in routine or toilet-training challenges
• Avoiding or holding in bowel movements
• Certain medications
• Conditions that affect the nerves, muscles or structure of the bowel

Sometimes there is no single identifiable cause.

Symptoms

Symptoms of chronic constipation may include:

• Hard, dry or painful stools
• Infrequent bowel movements
• Straining
• Very large stools
• Belly pain or bloating
• Stool withholding
• Stool accidents or leakage
• Decreased appetite

How we evaluate your child

We’ll talk with you about your child’s bowel habits, symptoms, diet, medications and previous treatments. We’ll also examine your child and look for signs that another condition may be contributing to their constipation. Many children do not need extensive testing. If constipation is severe or has not improved with treatment, we may recommend additional testing to better understand how the bowel is working.

Treatments

Treatment focuses on helping your child empty their bowel completely and develop regular, comfortable bowel movements. Depending on your child’s needs, treatment may include:

• A bowel cleanout to remove built-up stool
• Medications to keep stool soft and moving regularly
• Nutrition and hydration changes
• Regular bathroom routines
• A personalized bowel management plan

Our team works with your family to find a routine that can be maintained at home and adjusted as your child grows.

A cloacal malformation is a rare condition present at birth in girls in which the rectum, vagina and urinary tract join together instead of developing as three separate openings. Cloacal malformations can affect bowel, bladder, kidney and reproductive function and require coordinated care from several pediatric specialties.

Symptoms

A cloacal malformation is usually recognized at birth. Signs may include:

• One opening instead of separate openings for the anus, vagina and urinary tract
• Difficulty passing stool
• Difficulty urinating
• Swelling in the belly
• Urinary tract infections
• Kidney or urinary tract problems

The effects of a cloacal malformation can change as your child grows, particularly as they reach puberty and adolescence.

How we evaluate your child

Our team uses imaging and other testing to understand how your child’s digestive, urinary and reproductive organs developed and how they connect.

Because several organ systems are involved, your child will be evaluated by colorectal surgery, urology and pediatric and adolescent gynecology specialists. Working together allows us to create one coordinated treatment plan.

Treatments

Children born with a cloacal malformation will need surgery to separate and reconstruct the affected organs. Girls with a cloacal malformation will require multiple surgeries. The specific procedures and timing depend on your child’s anatomy and individual needs.

Long-term care may also include:

• Bowel management
• Bladder management
• Kidney monitoring
• Gynecologic care
• Support through puberty and adolescence

Our team continues to follow your child as they grow so we can address changing bowel, bladder and reproductive health needs.

Encopresis, also called soiling, is repeated stool leakage or stool accidents in a child who is past toilet-training age. Encopresis is most often related to chronic constipation and stool buildup and is not something a child can control or do intentionally.

When stool stays in the rectum for too long, it can become large and hard. Over time, the rectum may stretch, making it harder for your child to recognize when they need to have a bowel movement. Liquid stool can then leak around the built-up stool and into your child’s underwear.

Some children also begin holding their stool because they are afraid a bowel movement will hurt, which can make the problem worse.

Symptoms

Children with encopresis may experience:

• Stool accidents or soiled underwear
• Hard or very large stools
• Infrequent bowel movements
• Belly pain or bloating
• Stool withholding
• Reduced awareness of the need to have a bowel movement

How we evaluate your child

We’ll talk with you and your child about bowel habits, stool accidents, toilet routines and previous constipation treatments. We’ll also evaluate whether stool buildup or another bowel condition may be contributing to the accidents.

Additional testing is not always needed but may be recommended when symptoms are severe or do not improve with treatment.

Treatments

Treatment focuses on removing built-up stool and helping your child establish regular bowel movements. Treatment may include:

• A bowel cleanout
• Medications to keep stool soft and regular
• Scheduled bathroom visits
• Nutrition and hydration guidance
• Behavioral support
• A structured bowel management plan

Treatment will take time. Our team works with your family to adjust the plan as needed and help your child have more predictable bowel movements and fewer accidents.

Fecal incontinence is difficulty controlling bowel movements, resulting in accidental stool leakage. Fecal incontinence may happen when the muscles, nerves or structures involved in bowel control do not work as expected. It can occur in children with anorectal malformations, spinal conditions, previous colorectal surgery or other conditions affecting bowel function.

Several conditions can affect a child’s ability to control bowel movements, including:

• Anorectal malformations
• Hirschsprung disease
• Spinal or nerve conditions
• Previous colorectal surgery
• Severe or long-term constipation

Understanding why your child is having accidents helps us determine the most likely treatment.

Symptoms

Fecal incontinence can range from occasional accidents to frequent stool leakage. Your child may also experience:

• Difficulty recognizing the need to have a bowel movement
• Constipation
• Frequent or urgent bowel movements
• Difficulty completely emptying the bowel
• Skin irritation around the anus
• Difficulty staying clean throughout the day

How we evaluate your child

Our team looks at your child’s medical and surgical history, bowel habits, and daily symptoms. Depending on the cause, additional testing may help us understand your child’s anatomy and how well their bowel is working.

Treatments

Treatment is personalized around your child’s condition, bowel function and daily routine. The goal is to help your child empty their bowel on a predictable schedule and reduce accidents.

Treatment may include:

• Medications
• Enemas to help empty the lower bowel
• A personalized bowel management plan
• Surgical treatment when needed

As children get older, we can also help them become more independent in managing their bowel routine.

Female pelvic organ anomalies are differences in how one or more pelvic organs develop before birth. The pelvis contains parts of the digestive, urinary and reproductive systems, including the rectum, bladder, vagina and uterus. Because these organs develop close together, a difference involving one organ may sometimes affect others.

Pelvic organ differences can vary widely and may involve:

• The vagina or uterus
• The rectum or anus
• The bladder or urinary tract
• Connections between two organs that normally remain separate
• More than one pelvic organ system

Symptoms

Some pelvic organ anomalies are identified at birth, while others may not become noticeable until later in childhood or adolescence. Symptoms may include:

• Constipation or difficulty passing stool
• Urinary problems
• Frequent urinary tract infections
• Belly or pelvic discomfort
• Differences in the appearance of the pelvic organs
• Menstrual concerns during adolescence

How we evaluate your child

Imaging and other testing help us understand your child’s anatomy and determine which organs are involved. Your child may be evaluated by specialists in colorectal surgery, urology and pediatric and adolescent gynecology so we can look at their needs as a whole.

Treatments

Treatment depends on which organs are affected and whether the condition is causing symptoms. Some children only need monitoring, while others may need:

• Bowel or bladder management
• Gynecologic care
• Surgery to repair or reconstruct affected structures
• Coordinated long-term follow-up

We continue to support your child through childhood, puberty and adolescence as their needs change.

Hirschsprung disease is a condition present at birth in which nerve cells are missing from part of the large intestine. These nerve cells normally help the bowel muscles move stool forward. Without them, stool backs up, leading to severe constipation or a bowel blockage.

Symptoms

Symptoms often begin shortly after birth, but children with a shorter affected section of bowel may not be diagnosed until later.

Symptoms may include:

• Not passing the first bowel movement soon after birth
• A swollen belly
• Vomiting
• Severe or ongoing constipation
• Difficulty feeding
• Poor weight gain

Children with Hirschsprung disease are also at risk for enterocolitis, a serious inflammation and infection of the intestine. Fever, a swollen belly, vomiting or sudden watery diarrhea may be signs of enterocolitis and need prompt medical attention.

How we diagnose Hirschsprung disease

If we suspect Hirschsprung disease, testing includes imaging and a rectal biopsy, which involves taking a very small tissue sample from the rectum. The sample is examined for the nerve cells that are missing in Hirschsprung disease.

Testing helps us confirm the diagnosis and understand how much of the bowel may be affected.

Treatments

Children with Hirschsprung disease need surgery to remove the section of bowel without normal nerve cells and connect the healthy bowel to the anus.

After surgery, some children continue to experience constipation, stooling difficulties or problems controlling bowel movements. Our team provides ongoing follow-up and bowel management when needed to help your child achieve the best possible bowel function.

Rectal prolapse occurs when part of the rectum, the last section of the large intestine, slips through the anus and becomes visible outside the body. It most commonly happens during a bowel movement and may be related to constipation, frequent straining, or another underlying condition.

Several things can contribute to rectal prolapse in children, including:

• Chronic constipation and straining
• Frequent diarrhea
• Conditions that affect the muscles supporting the rectum
• Certain digestive or neurologic conditions

Sometimes more than one factor contributes to the prolapse.

Symptoms

The most noticeable sign is red or pink tissue coming out of the anus, usually during or after a bowel movement. Your child may also have:

• Discomfort during bowel movements
• Rectal bleeding
• Mucus or drainage
• Constipation
• Frequent straining

How we evaluate your child

We’ll ask about your child’s bowel habits and when the prolapse occurs and examine the area. We may recommend additional testing if we suspect constipation or another medical condition is contributing to the problem.

Treatments

Treatment often starts by addressing the underlying cause. For children with constipation, keeping stool soft and reducing straining may allow the rectum to heal and prevent repeated prolapse.

Treatment may include:

• Medications to keep stool soft
• Nutrition and hydration changes
• Regular bathroom routines
• Treatment of an underlying condition

If the prolapse continues despite these treatments, a procedure or surgery may be recommended.

Rectal stenosis is a narrowing of the rectum, the last part of the large intestine. When the rectum is narrower than normal, stool may have difficulty passing through. Rectal stenosis may be present at birth or develop after surgery, inflammation or injury.

Symptoms

Symptoms depend on how narrow the rectum is and may include:

• Difficulty passing stool
• Narrow or small stools
• Constipation
• Straining during bowel movements
• Belly pain or swelling

More severe narrowing can prevent stool from moving through normally and may cause a bowel blockage.

How we evaluate your child

Our specialists examine your child and may use imaging or other testing to determine where the narrowing is, how severe it is and how it is affecting bowel movements.

We’ll also look at your child’s medical and surgical history to help determine why the narrowing developed.

Treatments

Treatment depends on the severity and cause of the rectal stenosis. Options may include:

• Treatment for constipation
• Bowel management
• Rectal dilation, which gently stretches the narrowed area to make it easier for stool to pass
• Surgery for more significant narrowing

We continue to monitor your child’s bowel function and adjust treatment as they grow.

Spinal or sacral disorders affecting the bowel are conditions involving the spine, spinal cord or sacrum, the bone at the bottom of the spine, that interfere with the nerves controlling bowel movements. These may include spina bifida, spinal cord injuries, differences in how the sacrum developed or tumors affecting the area.

When these nerves do not work normally, a child may have difficulty feeling when their bowel is full, pushing stool out or controlling when a bowel movement happens.

Symptoms

Depending on which nerves are affected, symptoms may include:

• Chronic constipation
• Stool accidents or fecal incontinence
• Difficulty completely emptying the bowel
• Reduced awareness of the need to have a bowel movement
• Belly pain or bloating

Some children also have bladder control problems because nearby nerves help control both bowel and bladder function.

How we evaluate your child

We consider your child’s spinal condition, medical history, bowel habits and bladder symptoms to understand how nerve function may be affecting the bowel.

Testing may be recommended to evaluate your child’s anatomy and how effectively they are emptying their bowel. We may also coordinate with specialists who care for your child’s spine, nerves and urinary system.

Treatments

Treatment focuses on helping your child empty their bowel completely and on a predictable schedule. Depending on your child’s needs, treatment may include:

• Medications to regulate bowel movements
• Enemas to empty the bowel
• Irrigation to flush stool from the bowel
• A personalized bowel management plan
• Surgical treatment when needed

As your child grows, we can adjust their bowel routine and help them develop greater independence in managing their care.

The CHARM Program provides specialized, coordinated care for children with colorectal, anorectal and pelvic conditions that can affect bowel function and bowel control. We care for children with anorectal malformations, Hirschsprung disease, cloacal malformations, fecal incontinence and other conditions that may require long-term colorectal care.

Our team brings together the specialists your child needs to coordinate evaluation, treatment, surgery when needed and ongoing bowel management.

The CHARM Program treats conditions involving the colon, rectum, anus and surrounding pelvic structures. These include anorectal malformations, cloacal malformations, Hirschsprung disease, rectal prolapse, rectal stenosis, chronic constipation, fecal incontinence and bowel problems related to spinal or sacral disorders.

We also care for children who continue to have bowel function or bowel control concerns after colorectal surgery.

Your child may benefit from the CHARM Program if they were born with a colorectal or pelvic condition, have had colorectal surgery or experience ongoing problems with constipation, bowel movements or stool control that require specialized care.

Children may also be referred when a condition affects more than one body system and requires coordinated care from colorectal surgery and other pediatric specialists.

Chronic bowel diseases and conditions include a wide range of disorders that can affect how the intestines and bowel work. The CHARM Program specifically cares for colorectal conditions that can cause long-term problems with bowel function, including Hirschsprung disease, anorectal malformations, chronic constipation and conditions that cause fecal incontinence.

Other chronic digestive disorders, such as inflammatory bowel disease (IBD), may be treated through another specialized pediatric gastroenterology program.

Bowel management is a personalized treatment plan designed to help your child empty their bowel regularly and predictably. It can be especially helpful for children with fecal incontinence, chronic constipation, anorectal malformations, Hirschsprung disease, spinal conditions or ongoing bowel problems after colorectal surgery.

Your child’s plan may include medications, enemas, irrigations, nutrition changes, regular bathroom routines, and referrals to additional services such as behavioral health, physical therapy, and occupational therapy. The goal is to reduce constipation and stool accidents and help your child participate more comfortably and confidently in everyday activities.

Surgery can correct the structure of the bowel, rectum or anus, but some children continue to experience constipation, stool accidents or difficulty controlling bowel movements afterward. This may be related to how the muscles, nerves or bowel function after surgery.

The CHARM Program provides long-term follow-up and bowel management to help children achieve more regular, predictable bowel movements and improve bowel control.

Some colorectal and pelvic conditions require ongoing care throughout childhood and adolescence. Your child’s bowel function and treatment needs can change as they grow, become toilet trained, start school and become more independent.

Our team can adjust your child’s bowel management and other treatments over time, with the goal of helping them become as comfortable, confident and independent as possible.